A Single-Center Retrospective and Descriptive Study of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 Epidemic

A Single-Center Retrospective and Descriptive Study of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 Epidemic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research A Single-Center Retrospective and Descriptive Study of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 Epidemic Zhi-Ming Zhao, Xiu-Ping Zhang, Shuai Xu, Xiang-Long Tan, Xuan Zhang, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-40427/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: In the battle against COVID-19, most medical resources in China have been directed to infected patients in Wuhan. Thus, patients with hepatobiliary pancreatic tumors who are not suffering from COVID-19 are often not given timely and effective anti-cancer treatments. In this study, we aimed to describe clinical characteristics, treatment, and outcomes of patients with hepatobiliary and pancreatic oncology from our department, which retained normal working during the COVID-19 epidemic. We also sought to formulate a set of standardized hospitalization and treatment processes. Methods: A retrospective and descriptive study was conducted involving patients hospitalized from February 1, 2020, to February 29, 2020 (Return to work after the Spring Festival), at our Department of Hepatobiliary and Pancreatic Surgical Oncology. Results: The study included 92 patients from 12 provinces in the north of China who underwent surgical resection at our Department of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 epidemic. Robotic surgery was performed on 82% (75/92) of patients, while the rest underwent laparoscopic (2/92) and open surgery (15/92). Eighty-six patients had malignant tumor, and six had emergency benign diseases. Only five patients had severe pancreatic fistula, and three had biliary fistula after operation. Conclusions: The standardized hospitalization and treatment processes described in this study could prevent cross-infection of patients and still ensure timely treatment of patients with hepatobiliary and pancreatic cancers. These study findings will guide the management of surgical oncology departments and treatment of patients with hepatobiliary and pancreatic oncology during serious epidemics. Cancer Biology Oncology COVID-19 epidemic Hepatobiliary pancreatic tumor Robotic Surgery Retrospective and descriptive study Figures Figure 1 Figure 2 Figure 3 Introduction Coronaviruses are enveloped, non-segmented, positive-sense RNA viruses broadly distributed in humans and other mammals. 1 Although most human coronavirus infections are mild, epidemics of the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) together caused more than 10,000 cases in the past two decades, with mortality rates of 10% for SARS-CoV and 37% for MERS-CoV. 2 – 4 Wuhan, the capital of Hubei province in China, is investigating an outbreak of atypical pneumonia caused by the zoonotic severe acute respiratory syndrome coronavirus 2 or the novel 2019 coronavirus (COVID-19). 5 In the early stages of this pneumonia, severe acute respiratory infection symptoms occur, with some patients rapidly developing acute respiratory distress syndrome, acute respiratory failure, and other serious complications. The National Health Commission of China has developed a case-definition system to facilitate the classification of patients (panel). To mitigate the spread of the virus, the Chinese Government has progressively implemented metropolitan-wide quarantine of Wuhan and several nearby cities since Jan 24, 2020. 6 In the battle against COVID-19, most medical resources have been directed to infected patients in Wuhan, resulting in many hospitals being closed or open to emergencies only. Thus, many patients with malignancies were denied curative therapies, leading to an increase in non-infectious deaths during isolation at home. Patients with cancer who were not infected with COVID-19 were denied timely and effective anti-cancer treatments. Hepatobiliary pancreatic tumors are one of the most common cancers and the leading cause of cancer-related death worldwide. 7 Patients with liver, gallbladder, or pancreatic cancer have fast progression and poor prognosis. With recent improvements in surgical techniques (robotic and laparoscopic surgery), 8 , 9 medical care, and non-surgical treatment (radiotherapy, chemotherapy, and targeted therapy), treatment modalities in these patients vary greatly among different institutions. 10 , 11 Clearly, timely and effective treatments should be given to these patients. Therefore, in light of the COVID-19 epidemic, clinicians must consider how to reasonably allocate limited medical resources and establish a balanced medical security system to ensure that patients with hepatobiliary pancreatic tumor receive proper treatment. Research has focused increasingly on patients infected with COVID-19, with the epidemiology and clinical features of patients with confirmed 2019­nCoV pneumonia being explored in depth. 12 – 14 However, few studies have investigated the clinical treatment and management of patients with hepatobiliary and pancreatic oncology during the COVID-19 epidemic and clinical approaches taken by departments of hepatobiliary and pancreatic surgical oncology. Therefore, we aimed to describe clinical, laboratory, and radiological characteristics, as well as treatment and outcomes of patients with hepatobiliary and pancreatic oncology treated in our department, which maintained normal working hours during the COVID-19 epidemic. In addition, as hepatobiliary surgeons, we performed timely treatment of patients with hepatobiliopancreatic tumors, avoiding cross-infection of patients and formulating a standardized treatment process. We hope our study findings will guide the management of surgical oncology departments and treatment of patients with hepatobiliary and pancreatic oncology during serious epidemics. Methods Admission process during COVID-19 epidemic Our hospital did not completely halt services to some patients who needed to visit the Hepatobiliary and Pancreatic Surgical Oncology outpatient department during the COVID-19 outbreak, nor did we cease hepatobiliary and pancreatic surgery, although we did limit the department to emergency operations and elective surgeries for patients with hepatobiliary and pancreatic cancers. To meet the medical requirements and reduce the flow of patients to the hepatobiliary pancreatic surgery clinic, we began free online and telephone hepatobiliary and pancreatic consultation. Patients made an advanced appointment to receive this medical service. People entering the outpatient and inpatient buildings were required to wear masks and had their body temperature checked by professionals wearing tight protective clothing. At the entrance to the building, anyone with a fever (body temperature ≥ 37.3℃), a travel history to Hubei in the last 2 weeks, clear contact with Hubei residents in the last 2 weeks, or contact with people having fever were sent directly to the fever clinic for screening; those who had been exposed were quarantined for 2 weeks, while those with potential exposure were asked to quarantine themselves at home for 2 weeks. At the hepatobiliary pancreatic surgery clinic, patients were not allowed to take off their masks. Doctors were required to wear masks, surgical caps, protective suits, gloves, and goggles at work, and to take off their protective equipment only after their work in a designated disposal area. All patients were first isolated in the local community for 14 days. When they were admitted to the hospital, they made an appointment for medical treatment in the Department of Hepatobiliary and Pancreatic Surgical Oncology. A chest plain scan computed tomography (CT) was performed in the outpatient department. Those with normal inspection results were then issued a hospital admission form. If the patients had fever symptoms, they were required to have a throat swab examination. After admission, they were isolated in the transitional ward for 3 days; they then underwent preoperative examination and surgery. Study population A retrospective study was conducted on patients hospitalized from February 1, 2020, to February 29, 2020 (Return to work after the Spring Festival), at the Department of Hepatobiliary and Pancreatic Surgical Oncology, during the COVID-19 epidemic. Clinical and pathological data of these patients were retrospectively analyzed. The present study was approved by our Institutional Ethics Committee. Informed consent was obtained from all patients for their data to be used for research. In addition, this study included patients’ basic information gathered between 2017 and 2019. Inclusion and exclusion criteria The inclusion criteria were patients with hepatobiliary and pancreatic cancer with: (1) good basic state and liver function (Child–Pugh score of A or B7 ≤ 7); (2) complete preoperative serological data and contrast-enhanced CT or MRI of the abdomen; (3) surgical resection with no residual tumors left, based on both gross inspection and histological examination of the resection specimens; (4) histopathological diagnosis of hepatobiliary or pancreatic cancer; (5) no macrovascular invasion or extrahepatic metastasis; and (6) complete pathological and clinical data during follow-up. The exclusion criteria were: (1) a history of other cancers; and (2) incomplete clinical data. Preoperative and postoperative investigations Routine preoperative investigations included imaging and serological tests. All patients underwent a standard hepatobiliary and pancreatic surgery imaging protocol that included abdominal ultrasonography, contrast-enhanced MRI and/or CT scan of the abdomen, and plain radiography or non-contrast CT scan of the chest. All radiological examinations were reviewed by two experienced radiologists. Routine preoperative laboratory investigations included complete blood counts, liver and renal function tests, and tumor marker level. The coagulability state and infection index were obtained before surgery. Routine postoperative investigations included histopathology and immunohistochemical studies. Other pathological indexes used in this study included maximum tumor diameter, number of tumors, and tumor encapsulation. Histopathological evaluations were performed by two independent and experienced pathologists who were blinded to the clinical data. Treatment All patients were assessed by a multidisciplinary team of experienced liver surgeons, oncologists, radiologists, and hepatologists at our hospital. Surgical resection was the treatment of choice if the disease was resectable. Surgical procedures have been reported previously, including open surgery, laparoscopic surgery, and robotic surgery. Follow-up Patients who underwent surgery were followed up once every day. In particular, their body temperature, infection index, and surgical related complications were recorded. Surgical complications and death were recorded during the postoperative hospital stay. This study was censored on March 1, 2020. Statistical analysis To compare baseline variables, the Student’s t-test was used for continuous variables and the χ2 test for categorical variables. Survival curves and univariate analyses were conducted using the Kaplan–Meier method, and differences were analyzed using the log-rank test. Prognostic factors that were significant on univariate analysis (P < 0.05) were subjected to multivariate analysis using the Cox proportional hazards regression model. All reported P-values were two-sided. A significance level of 0.05 was applied throughout. Statistical analyses were performed using the R statistical package, Version 3.4.3 (R Development Team, Vienna, Austria). Results Changes of disease spectrum Our hospital treated 92 patients from 12 provinces in the north of China during the COVID-19 epidemic (Fig. 1 ). In the time period from 2017 to 2020, the proportion of patients with malignant tumors increased significantly, even though the total number of surgical patients decreased (Fig. 2 ). During the COVID-19 epidemic, limited medical resources were directed to patients with malignant tumors. The use of robotic surgery also increased, which indicated that minimally invasive surgery can accelerate the recovery of patients after surgery (Fig. 3 ). Patient characteristics All 92 patients with hepatobiliary pancreatic diseases in this study were hospitalized during the outbreak from February 1, 2020, to February 29, 2020 (after the Spring Festival in China). They were divided into two groups according to their gender (66 men; 26 women). Baseline characteristics of all patients with hepatocellular carcinoma are detailed in Table 1 . All patients had a normal body temperature (< 37.3℃) before surgery. Preoperative chest CT was normal in 90.2% of patients; 6.5% had cardiopulmonary changes, all of whom were elderly, and one patient had bacterial pneumonia, old tuberculosis, or solid pulmonary nodule. None of the variables listed above showed any significant difference between the groups, except for weight and height (Table 1 ). Table 1 The clinical features of patients in our Department of Hepatobiliary and Pancreatic Surgical Oncology (n = 92) Variables Total (N = 92) Male (N = 66) Female (N = 26) P-value Age 58.21 ± 11.59 58.22 ± 11.282 58.74 ± 11.061 0.896 ≦ 50 21(22.8%) 15(22.7%) 6(23.1%) 0.971 > 50 71(77.2%) 51(77.3%) 20(76.9%) Temperature 36.58 ± 0.29 36.61 ± 0.28 36.53 ± 0.30 0.245 < 37.3℃ 92(100%) 66(100%) 26(100%) ≥ 37.3℃ 0(0%) 0(0%) 0(0%) RBC (10^12/L) 4.03 ± 0.65 4.07 ± 0.72 3.92 ± 0.44 0.209 5.5 0(0%) 0(0%) 0(0%) WBC (10^9/L) 6.34 ± 2.78 6.01 ± 1.81 7.17 ± 4.30 0.195 10 4(4.3%) 1(1.5%) 3(11.5) Neutrophil proportion 0.62 ± 0.11 0.62 ± 0.09 0.63 ± 0.15 0.820 0.7 17(18.5%) 10(15.2%) 7(26.9%) Lymphocyte proportion 0.27 ± 0.10 0.27 ± 0.09 0.28 ± 0.12 0.569 0.4 12(13.0%) 7(10.6%) 5(19.2%) CRP (mg/L) 3.68 ± 3.54 3.49 ± 3.51 4.15 ± 3.66 0.451 ≤ 10 85(92.4%) 61(92.4%) 24(92.3%) 1.000 > 10 7(7.6%) 5(7.6%) 2(7.7%) AST(U/L) 47.29 ± 46.88 46.38 ± 44.60 49.62 ± 53.09 0.767 ≤ 35 52(56.5%) 37(56.1%) 15(57.7%) 0.887 > 35 40(43.5%) 29(43.9%) 11(42.3%) ALT(U/L) 62.25 ± 80.89 68.50 ± 91.80 46.39 ± 39.25 0.271 ≤ 40 46(50.0%) 32(48.5%) 14(53.8%) 0.643 > 40 46(50.0%) 34(51.5%) 12(46.2%) CR (umol/L) 72.14 ± 18.11 74.43 ± 17.95 66.34 ± 17.54 0.053 ≤ 105 90(97.8%) 64(97.0%) 26(100.0%) 1.000 ༞105 2(2.2%) 2(3.0%) 0(0%) BUN (mmol/L) 6.00 ± 10.03 6.53 ± 11.75 4.64 ± 2.05 0.036 ≤ 7.1 81(88.0%) 58(87.9%) 23(88.5%) 1.000 ༞7.1 11(12.0%) 8(12.1%) 3(11.5%) Chest CT Normal 83(90.2%) 58(87.9%) 25(96.2%) 0.879 Cardiopulmonary changes in the elderly 6(6.5%) 5(7.6%) 1(3.8%) Bacterial pneumonia 1(1.1%) 1(1.5%) 0(0.0%) Old tuberculosis 1(1.1%) 1(1.5%) 0(0.0%) Solid pulmonary nodule 1(1.1%0 1(1.5%) 0(0.0%) Previous surgical history yes 27(29.3%) 15(22.7%) 12(46.2%) 0.026 no 65(70.7%) 51(77.3%) 14(53.8%) Weight (kg) 68.60 ± 11.11 70.71 ± 10.92 63.25 ± 9.89 0.003 Height (cm) 168.75 ± 6.80 171.67 ± 4.98 161.35 ± 4.95 0.000 BMI(kg/m 2 ) 24.08 ± 3.59 23.98 ± 3.50 24.32 ± 3.86 0.685 Preoperative time (d) 7.25 ± 3.41 7.43 ± 3.63 6.79 ± 2.77 0.420 Postoperative time (d) 8.33 ± 3.25 8.69 ± 3.42 7.43 ± 2.65 0.095 Time in hospital (d) 15.58 ± 5.25 16.12 ± 5.51 14.22 ± 4.30 0.120 Intraoperative hemorrhage (ml) 190.39 ± 83.24 196.76 ± 84.42 174.23 ± 79.44 0.245 Hepatectomy 143.93 ± 65.06 (n = 28) 147.14 ± 62.46 (n = 21) 134.29 ± 76.78 (n = 7) 0.659 Radical resection of hilar cholangiocarcinoma 215.00 ± 63.03 (n = 12) 226.25 ± 60.93 (n = 8) 192.50 ± 69.94 (n = 4) 0.408 Radical cholecystectomy 200.00 ± 50.00 (n = 3) 200.00 ± 50.00 (n = 3) 0 PD 267.42 ± 58.82 (n = 31) 266.40 ± 59.36 (n = 25) 271.67 ± 61.78 (n = 6) 0.848 RAMPS 106.15 ± 27.25 (n = 12) 97.50 ± 31.51 (n = 7) 120.00 ± 10.00 (n = 5) 0.155 Pancreatic tumor enucleation 50 (n = 1) 50 (n = 1) 0 Others 116.00 ± 33.62 (n = 5) 140.00 (n = 1) 110.00 ± 35.59 (n = 4) 0.506 Operation time (min) 193.87 ± 49.31 197.00 ± 52.86 185.92 ± 38.66 0.272 Hepatectomy 173.00 ± 46.53 (n = 28) 172.90 ± 53.49 (n = 21) 173.29 ± 14.33 (n = 7) 0.977 Radical resection of hilar cholangiocarcinoma 218.92 ± 54.85 (n = 12) 206.50 ± 45.07 (n = 8) 243.75 ± 71.12 (n = 4) 0.288 Radical cholecystectomy 239.33 ± 35.45 (n = 3) 239.33 ± 35.45 (n = 3) 0 PD 220.52 ± 39.95 (n = 31) 218.52 ± 39.62 (n = 25) 228.83 ± 44.01 (n = 6) 0.579 RAMPS 198.69 ± 25.88 (n = 12) 209.00 ± 25.96 (n = 7) 182.20 ± 16.67 (n = 5) 0.066 Pancreatic tumor enucleation 195 (n = 1) 195 (n = 1) 0 Others 104.20 ± 32.74 (n = 5) 134.00 (n = 1) 96.75 ± 32.55 (n = 4) 0.381 Operative characteristics During the COVID-19 epidemic, 82% of the patients (75/92) underwent robotic surgery, while the rest were treated using laparoscopic (2/92) or open (15/92) surgery. Operations performed in February 2020 included partial hepatectomy, resection of hilar cholangiocarcinoma, pancreaticoduodenectomy, distal pancreatic resection, and others (including benign and malignant cholecystectomy). All details are shown in Table 2 . Table 2 Operations carried out during February 2020 in our Department of Hepatobiliary and Pancreatic Surgical Oncology (n = 92) Operation Surgical procedures Robotic Laparoscopic Open Partial hepatectomy 16 0 1 Hemihepatectomy 7 0 3 Middle hepatectomy 1 0 0 Radical resection of hilar cholangiocarcinoma 10 0 2 Radical cholecystectomy 3 0 0 PD 26 0 5 RAMPS 12 0 0 Pancreatic tumor enucleation 1 0 0 Others 1 2 2 Summary (%) 77 (83.7%) 2 (2.2%) 13 (14.1%) Abbreviation : PD: Pancreaticoduodenectomy; RAMPS: Radical antegrade modular pancreatosplenectomy. Pathological characteristics Among all 92 patients, 86 had malignant tumor and six had benign tumor. Pathological results were pancreatic malignant tumor, cholangiocarcinoma, hepatic carcinoma, periampullary carcinoma, and acute benign diseases. All details are shown in Table 3 . Table 3 The pathology results of patients in our Department of Hepatobiliary and Pancreatic Surgical Oncology Pathology results Subtotal Ratio Pancreatic head carcinoma Pancreatic malignant tumor (25) 11 44.0% Distal pancreatic cancer 12 48.0% Insulinoma of the pancreatic body 1 4.0% The pancreatic head IPMN 1 4.0% Carcinoma of the lower middle bile duct Cholangiocarcinoma (28) 13 46.4% Hilar cholangiocarcinoma 12 42.9% Carcinoma of gallbladder 3 10.7% Hepatic metastatic carcinoma Malignant tumors of the liver(27) 9 33.3% Primary liver cancer 18 66.7% Periampullary carcinoma Periampullary carcinoma (6) 6 100.0% Hepatic echinococcosis Benign diseases (6) 1 16.7% Gallstone, acute cholecystitis 4 66.7% Bile - intestinal anastomosis stenosis 1 16.7% Summary Malignant 86 93.5% Benign 6 6.5% Postoperative complications Major postoperative complications after hepatobiliary pancreatic surgery included pancreatic fistula, biliary fistula, and bleeding. Only five patients had severe pancreatic fistula after operation. Three cases of biliary fistula occurred, one of which was severe. In addition, 2 of the 92 patients had postoperative bleeding and underwent emergency interventional embolization to return to stable condition. All details are shown in Table 4 . Table 4 Perioperative outcomes of patients in our Department of Hepatobiliary and Pancreatic Surgical Oncology during February 2020 Male Female Total P-value Pancreatic fistula (n = 44) BL 24(72.8%) 8(72.8%) 32(72.8%) 1.000 B 6(18.2%) 2(18.2%) 8(18.2%) C 3(9.1%) 1(9.1%) 4(9.1%) Biliary fistula (n = 79) No 56 (96.6%) 21 (100.0%) 77 (97.5%) 1.000 Yes 2 (3.4%) 0 (0.0%) 2 (2.5%) Bleeding (n = 92) No 64 (97.0%) 26 (100.0%) 90 (97.8%) 1.000 Yes 2 (3.0%) 0 (0.0%) 2 (2.2%) Discussion In the space of just 3 months, a novel coronavirus—a family that historically was not viewed as a global health concern—has become daily headline news worldwide. Studies have shown that the disease, recently named COVID-19 (coronavirus disease 2019, COVID-19) by the World Health Organization (WHO), can induce symptoms including fever, dry cough, dyspnea, fatigue, and lymphopenia in infected patients. 15 , 16 In more severe cases, infections cause viral pneumonia that can lead to SARS and even death. Since the first report of COVID-19 in December 2019 in Wuhan, China, the outbreak of the disease is has been continuously evolving. 12 , 17 during the COVID-19 epidemic, many medical resources have been directed to infected patients and many hospitals have closed. As a result, patients with malignant tumors often lose their best treatment opportunities. Hepatobiliary pancreatic tumors are one of the most common cancers. 11 , 18 Patients with liver cancer, gallbladder cancer, or pancreatic cancer have a fast progression and poor prognosis. Our hepatobiliary pancreatic surgical oncology department performed 92 operations in February 1–29, 2020, during the most serious stage of the epidemic. In this study, we summarized the process management of patients with hepatobiliary pancreatic tumors during the outbreak, and clinical and surgical characteristics and postoperative complications in 92 patients. We believe that our experience will help other clinicians working during the epidemic. Recent studies have reported that rapid person-to-person transmission of COVID-19 occurs. 10 , 19 , 20 In addition, COVID-19 has been detected in stool samples of patients with abdominal symptoms. However, it is difficult to differentiate and screen patients with typical symptoms. Nevertheless, rapid human-to-human transmission among close contacts is an important feature of the COVID-19 pneumonia. 21 Hospitals in all provinces and cities across China have taken effective measures to control the spread of COVID-19. However, suspected or uninfected patients with malignant tumors have often been isolated, so these patients cannot receive timely and effective treatments, leading to tumor progression and more non-infectious deaths because of malignant tumors rather than COVID-19 infection. Our department of hepatobiliary and pancreatic surgical oncology was the only surgical oncology department that continued normal operations in the capital of China during the outbreak; we established a relatively reasonable admission process to ensure diagnosis and treatment of patients with malignant tumor in the surrounding area. In addition, we performed surgery in 92 patients from 12 provinces in the north of China during the COVID-19 epidemic. The above admission process from our department may be worth introducing in other large regional hospitals. The advantages of minimally invasive surgery were demonstrated during the COVID-19 outbreak. 22 Robotic surgical systems, which were developed to address the disadvantages of laparoscopy, have made minimally invasive hepatobiliary and pancreatic surgery much more accessible to surgeons. 23 , 24 Among the 92 patients in this study, 93.5% had malignant tumors, requiring timely and effective surgical resection, and 81.5% were subjected to robotic surgery and 2.2% to laparoscopic surgery. Moreover, our department led the drafting and development of an international expert consensus on robotic pancreatic and robotic hepatectomy surgery. 25 , 26 Robotic surgery is as safe as laparoscopic and open surgery, with comparable intraoperative blood loss, length of hospital stay (LOS), overall postoperative complication rate, perioperative mortality, and rate of postoperative pancreatic fistula (POPF) to laparoscopic surgery. Moreover, robotic surgery has a longer operating time, less intraoperative blood loss, and shorter LOS than open surgery, whereas it has a similar overall complication rate, perioperative mortality, and POPF rate. 25 Taken together, robotic surgery has some advantages in patients with hepatobiliary pancreatic tumor, especially during COVID-19 outbreak, in that it decreases LOS and enhances recovery after surgery. The present study had some limitations. First, data came from a single center and were acquired retrospectively. Second, the study was descriptive, so it is unclear whether the results can be extrapolated to other public health events. Third, we only included patients who underwent emergency operations and elective surgeries for hepatobiliary and pancreatic cancers, so it remains to be confirmed whether the approach described is beneficial in patients with benign hepatobiliary and pancreatic diseases. In conclusion, we performed surgical resection in 92 patients with hepatobiliary and pancreatic oncology in a department that maintained a normal working regimen during the COVID-19 epidemic. Our standardized hospitalization and treatment processes could prevent cross-infection of patients and still ensure the timely treatment of patients with hepatobiliary and pancreatic cancers. These findings will guide the operation of surgical oncology departments and treatment of patients with hepatobiliary and pancreatic cancers during serious epidemics. Abbreviations RBC Red Blood Cell; WBC:White Blood Cell; CRP:C-reactive protein; ALT:Alanine Aminotransferase; AST:Aspartate Aminotransferase; CR:Creatinine; BUN:Blood Urea Nitrogen; BMI:Body Mass Index; PD:Pancreaticoduodenectomy ; RAMPS:Radical antegrade modular pancreatosplenectomy; Note The test result of the patient with pneumonia was negative for the COVID-19; Declarations Acknowledgements None Author contributions Conception and design: Rong Liu, Zhi-Ming Zhao, Xiu-Ping Zhang Provision of study materials or patients: Xiang-Long Tan, Xuan Zhang, Ming-Gen Hu, Cheng-Gang Li, Yuan-Xing Gao, Guo-Dong Zhao Collection and assembly of data: Zhi-Ming Zhao, Xiu-Ping Zhang, Shuai Xu Data analysis and interpretation: Zhi-Ming Zhao, Xiu-Ping Zhang, Shuai Xu Manuscript writing: Zhi-Ming Zhao, Xiu-Ping Zhang Final approval of manuscript: All authors Funding None Availability of data and materials The datasets used or analyzed during the current study are available from the corresponding author on reasonable request Ethics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. 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Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surgical endoscopy. 2016;30(3):1004–13. Choi GH, Chong JU, Han DH, Choi JS, Lee WJ. Robotic hepatectomy: the Korean experience and perspective. Hepatobiliary surgery nutrition. 2017;6(4):230–8. Liu R, Wakabayashi G, Palanivelu C, et al. International consensus statement on robotic pancreatic surgery. Hepatobiliary surgery nutrition. 2019;8(4):345–60. Liu R, Wakabayashi G, Kim HJ, et al. International consensus statement on robotic hepatectomy surgery in 2018. World journal of gastroenterology. 2019;25(12):1432–44. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-40427","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":779276,"identity":"43fc6c97-fac3-4d25-96de-674e225be3fd","order_by":0,"name":"Zhi-Ming Zhao","email":"","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhi-Ming","middleName":"","lastName":"Zhao","suffix":""},{"id":779277,"identity":"ed3c1b05-06ba-43c3-9b14-a23dcc4dba62","order_by":1,"name":"Xiu-Ping Zhang","email":"","orcid":"","institution":"PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiu-Ping","middleName":"","lastName":"Zhang","suffix":""},{"id":779278,"identity":"b5ea5b16-5069-4fa4-a18b-439743f81bf3","order_by":2,"name":"Shuai Xu","email":"","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shuai","middleName":"","lastName":"Xu","suffix":""},{"id":779279,"identity":"bf77f848-d62f-44fd-b544-ca79eb0b198c","order_by":3,"name":"Xiang-Long Tan","email":"","orcid":"","institution":"PLA Army General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiang-Long","middleName":"","lastName":"Tan","suffix":""},{"id":779280,"identity":"8e7bad2f-3c87-4a7d-b573-0c70b8f41917","order_by":4,"name":"Xuan Zhang","email":"","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xuan","middleName":"","lastName":"Zhang","suffix":""},{"id":779281,"identity":"c8a957db-4eea-4203-916f-6c98177bd653","order_by":5,"name":"Ming-Gen Hu","email":"","orcid":"","institution":"PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ming-Gen","middleName":"","lastName":"Hu","suffix":""},{"id":779282,"identity":"0e3a62aa-e642-40c8-99cb-192d95e9d9b3","order_by":6,"name":"Cheng-Gang Li","email":"","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cheng-Gang","middleName":"","lastName":"Li","suffix":""},{"id":779283,"identity":"f4ac7e43-cf94-431f-9893-9d513aa54afb","order_by":7,"name":"Yuan-Xing Gao","email":"","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuan-Xing","middleName":"","lastName":"Gao","suffix":""},{"id":779284,"identity":"8a81dbb0-0f2a-4598-b49a-86ad6e538892","order_by":8,"name":"Guo-Dong Zhao","email":"","orcid":"","institution":"PLA Army General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Guo-Dong","middleName":"","lastName":"Zhao","suffix":""},{"id":779285,"identity":"1dc917fd-f5c5-412b-b393-2df675a1a066","order_by":9,"name":"Rong Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYBACPmYIbcfGzHzgwIcKIrSwQbUk87OzJR6ccYYYLVCacWY/j/Fh3hZitLDzmH34uKOW2eAwz4cDvA0M8vxiBwg5jMd45swzx/kMDvNuOCC5g8Fw5uwEwlqYeduOMYO1GJ5hSDC4TaQWxg2HeR4cSGwjXksN48xmHoYDB4nTwlbMOLPtQDI/M5vBwYYzEoT9ws9/eDPDx7Y6Ozb+w48//6mwkeeXJqAFCg7DGBJEKQeBOqJVjoJRMApGwQgEAI8QPqXNkeI5AAAAAElFTkSuQmCC","orcid":"","institution":"Chinese People's Liberation Army(PLA) General Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Rong","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2020-07-06 19:22:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-40427/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-40427/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":1583384,"identity":"0eb8d41e-6bcf-43ff-82fe-dc99c3cde818","added_by":"auto","created_at":"2020-07-16 15:16:43","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54612,"visible":true,"origin":"","legend":"All 92 patients from 12 provinces in the north of China during the COVID-19 epidemic. Note: The designations employed and the presentation of the material on this map do not imply the expression of any opinion whatsoever on the part of Research Square concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. This map has been provided by the authors.","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-40427/v1/1.jpg"},{"id":1583385,"identity":"eb2800d6-9d20-4b4f-b85a-94af70d9cfa1","added_by":"auto","created_at":"2020-07-16 15:16:43","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":45988,"visible":true,"origin":"","legend":"Trends in disease types from 2017 to 2020 in the same time period. ","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-40427/v1/2.jpg"},{"id":1583386,"identity":"b7cdc81f-82fd-46a7-919b-b6021fccbd05","added_by":"auto","created_at":"2020-07-16 15:16:43","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":53572,"visible":true,"origin":"","legend":"Trends in surgical procedures from 2017 to 2020 in the same time period.","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-40427/v1/3.jpg"},{"id":13551492,"identity":"3371c323-fe51-4b29-88b2-d07fe9f819c4","added_by":"auto","created_at":"2021-09-17 02:28:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":717638,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-40427/v1/bccd850c-7078-4702-820f-ddac557f3d30.pdf"}],"financialInterests":"","formattedTitle":"A Single-Center Retrospective and Descriptive Study of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 Epidemic","fulltext":[{"header":"Introduction","content":" \u003cp\u003eCoronaviruses are enveloped, non-segmented, positive-sense RNA viruses broadly distributed in humans and other mammals.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Although most human coronavirus infections are mild, epidemics of the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) together caused more than 10,000 cases in the past two decades, with mortality rates of 10% for SARS-CoV and 37% for MERS-CoV.\u003csup\u003e\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Wuhan, the capital of Hubei province in China, is investigating an outbreak of atypical pneumonia caused by the zoonotic severe acute respiratory syndrome coronavirus 2 or the novel 2019 coronavirus (COVID-19).\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e In the early stages of this pneumonia, severe acute respiratory infection symptoms occur, with some patients rapidly developing acute respiratory distress syndrome, acute respiratory failure, and other serious complications. The National Health Commission of China has developed a case-definition system to facilitate the classification of patients (panel). To mitigate the spread of the virus, the Chinese Government has progressively implemented metropolitan-wide quarantine of Wuhan and several nearby cities since Jan 24, 2020.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In the battle against COVID-19, most medical resources have been directed to infected patients in Wuhan, resulting in many hospitals being closed or open to emergencies only. Thus, many patients with malignancies were denied curative therapies, leading to an increase in non-infectious deaths during isolation at home. Patients with cancer who were not infected with COVID-19 were denied timely and effective anti-cancer treatments.\u003c/p\u003e \u003cp\u003eHepatobiliary pancreatic tumors are one of the most common cancers and the leading cause of cancer-related death worldwide.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Patients with liver, gallbladder, or pancreatic cancer have fast progression and poor prognosis. With recent improvements in surgical techniques (robotic and laparoscopic surgery),\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e medical care, and non-surgical treatment (radiotherapy, chemotherapy, and targeted therapy), treatment modalities in these patients vary greatly among different institutions.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Clearly, timely and effective treatments should be given to these patients. Therefore, in light of the COVID-19 epidemic, clinicians must consider how to reasonably allocate limited medical resources and establish a balanced medical security system to ensure that patients with hepatobiliary pancreatic tumor receive proper treatment.\u003c/p\u003e \u003cp\u003eResearch has focused increasingly on patients infected with COVID-19, with the epidemiology and clinical features of patients with confirmed 2019\u0026shy;nCoV pneumonia being explored in depth.\u003csup\u003e\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e However, few studies have investigated the clinical treatment and management of patients with hepatobiliary and pancreatic oncology during the COVID-19 epidemic and clinical approaches taken by departments of hepatobiliary and pancreatic surgical oncology.\u003c/p\u003e \u003cp\u003eTherefore, we aimed to describe clinical, laboratory, and radiological characteristics, as well as treatment and outcomes of patients with hepatobiliary and pancreatic oncology treated in our department, which maintained normal working hours during the COVID-19 epidemic. In addition, as hepatobiliary surgeons, we performed timely treatment of patients with hepatobiliopancreatic tumors, avoiding cross-infection of patients and formulating a standardized treatment process. We hope our study findings will guide the management of surgical oncology departments and treatment of patients with hepatobiliary and pancreatic oncology during serious epidemics.\u003c/p\u003e "},{"header":"Methods","content":" \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAdmission process during COVID-19 epidemic\u003c/h2\u003e \u003cp\u003eOur hospital did not completely halt services to some patients who needed to visit the Hepatobiliary and Pancreatic Surgical Oncology outpatient department during the COVID-19 outbreak, nor did we cease hepatobiliary and pancreatic surgery, although we did limit the department to emergency operations and elective surgeries for patients with hepatobiliary and pancreatic cancers. To meet the medical requirements and reduce the flow of patients to the hepatobiliary pancreatic surgery clinic, we began free online and telephone hepatobiliary and pancreatic consultation. Patients made an advanced appointment to receive this medical service. People entering the outpatient and inpatient buildings were required to wear masks and had their body temperature checked by professionals wearing tight protective clothing. At the entrance to the building, anyone with a fever (body temperature\u0026thinsp;\u0026ge;\u0026thinsp;37.3℃), a travel history to Hubei in the last 2 weeks, clear contact with Hubei residents in the last 2 weeks, or contact with people having fever were sent directly to the fever clinic for screening; those who had been exposed were quarantined for 2 weeks, while those with potential exposure were asked to quarantine themselves at home for 2 weeks. At the hepatobiliary pancreatic surgery clinic, patients were not allowed to take off their masks. Doctors were required to wear masks, surgical caps, protective suits, gloves, and goggles at work, and to take off their protective equipment only after their work in a designated disposal area.\u003c/p\u003e \u003cp\u003eAll patients were first isolated in the local community for 14 days. When they were admitted to the hospital, they made an appointment for medical treatment in the Department of Hepatobiliary and Pancreatic Surgical Oncology. A chest plain scan computed tomography (CT) was performed in the outpatient department. Those with normal inspection results were then issued a hospital admission form. If the patients had fever symptoms, they were required to have a throat swab examination. After admission, they were isolated in the transitional ward for 3 days; they then underwent preoperative examination and surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eA retrospective study was conducted on patients hospitalized from February 1, 2020, to February 29, 2020 (Return to work after the Spring Festival), at the Department of Hepatobiliary and Pancreatic Surgical Oncology, during the COVID-19 epidemic. Clinical and pathological data of these patients were retrospectively analyzed. The present study was approved by our Institutional Ethics Committee. Informed consent was obtained from all patients for their data to be used for research. In addition, this study included patients\u0026rsquo; basic information gathered between 2017 and 2019.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria were patients with hepatobiliary and pancreatic cancer with: (1) good basic state and liver function (Child\u0026ndash;Pugh score of A or B7\u0026thinsp;\u0026le;\u0026thinsp;7); (2) complete preoperative serological data and contrast-enhanced CT or MRI of the abdomen; (3) surgical resection with no residual tumors left, based on both gross inspection and histological examination of the resection specimens; (4) histopathological diagnosis of hepatobiliary or pancreatic cancer; (5) no macrovascular invasion or extrahepatic metastasis; and (6) complete pathological and clinical data during follow-up. The exclusion criteria were: (1) a history of other cancers; and (2) incomplete clinical data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePreoperative and postoperative investigations\u003c/h2\u003e \u003cp\u003eRoutine preoperative investigations included imaging and serological tests. All patients underwent a standard hepatobiliary and pancreatic surgery imaging protocol that included abdominal ultrasonography, contrast-enhanced MRI and/or CT scan of the abdomen, and plain radiography or non-contrast CT scan of the chest. All radiological examinations were reviewed by two experienced radiologists. Routine preoperative laboratory investigations included complete blood counts, liver and renal function tests, and tumor marker level. The coagulability state and infection index were obtained before surgery. Routine postoperative investigations included histopathology and immunohistochemical studies. Other pathological indexes used in this study included maximum tumor diameter, number of tumors, and tumor encapsulation. Histopathological evaluations were performed by two independent and experienced pathologists who were blinded to the clinical data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTreatment\u003c/h2\u003e \u003cp\u003eAll patients were assessed by a multidisciplinary team of experienced liver surgeons, oncologists, radiologists, and hepatologists at our hospital. Surgical resection was the treatment of choice if the disease was resectable. Surgical procedures have been reported previously, including open surgery, laparoscopic surgery, and robotic surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFollow-up\u003c/h2\u003e \u003cp\u003ePatients who underwent surgery were followed up once every day. In particular, their body temperature, infection index, and surgical related complications were recorded. Surgical complications and death were recorded during the postoperative hospital stay. This study was censored on March 1, 2020.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eTo compare baseline variables, the Student\u0026rsquo;s t-test was used for continuous variables and the χ2 test for categorical variables. Survival curves and univariate analyses were conducted using the Kaplan\u0026ndash;Meier method, and differences were analyzed using the log-rank test. Prognostic factors that were significant on univariate analysis (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were subjected to multivariate analysis using the Cox proportional hazards regression model. All reported P-values were two-sided. A significance level of 0.05 was applied throughout. Statistical analyses were performed using the R statistical package, Version 3.4.3 (R Development Team, Vienna, Austria).\u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":" \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eChanges of disease spectrum\u003c/h2\u003e \u003cp\u003eOur hospital treated 92 patients from 12 provinces in the north of China during the COVID-19 epidemic (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the time period from 2017 to 2020, the proportion of patients with malignant tumors increased significantly, even though the total number of surgical patients decreased (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). During the COVID-19 epidemic, limited medical resources were directed to patients with malignant tumors. The use of robotic surgery also increased, which indicated that minimally invasive surgery can accelerate the recovery of patients after surgery (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eAll 92 patients with hepatobiliary pancreatic diseases in this study were hospitalized during the outbreak from February 1, 2020, to February 29, 2020 (after the Spring Festival in China). They were divided into two groups according to their gender (66 men; 26 women). Baseline characteristics of all patients with hepatocellular carcinoma are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. All patients had a normal body temperature (\u0026lt;\u0026thinsp;37.3℃) before surgery. Preoperative chest CT was normal in 90.2% of patients; 6.5% had cardiopulmonary changes, all of whom were elderly, and one patient had bacterial pneumonia, old tuberculosis, or solid pulmonary nodule. None of the variables listed above showed any significant difference between the groups, except for weight and height (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe clinical features of patients in our Department of Hepatobiliary and Pancreatic Surgical Oncology (n\u0026thinsp;=\u0026thinsp;92)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;92)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.21\u0026thinsp;\u0026plusmn;\u0026thinsp;11.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.22\u0026thinsp;\u0026plusmn;\u0026thinsp;11.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e58.74\u0026thinsp;\u0026plusmn;\u0026thinsp;11.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.896\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e≦\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(22.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6(23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71(77.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51(77.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e20(76.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTemperature\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e36.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;37.3℃\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e26(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;37.3℃\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRBC (10^12/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5(19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.770\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.5\u0026thinsp;~\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76(82.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e55(83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21(80.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWBC (10^9/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.34\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4(15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026thinsp;~\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78(84.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e59(89.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19(73.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1(1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(11.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeutrophil proportion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(12.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5(19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5\u0026thinsp;~\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62(67.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e48(72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14(53.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10(15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(26.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLymphocyte proportion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.569\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(19.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6(23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.456\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.2\u0026thinsp;~\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61(66.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e46(69.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15(57.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(13.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7(10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(19.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCRP (mg/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.49\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85(92.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61(92.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e24(92.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(7.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5(7.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(7.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAST(U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.29\u0026thinsp;\u0026plusmn;\u0026thinsp;46.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.38\u0026thinsp;\u0026plusmn;\u0026thinsp;44.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e49.62\u0026thinsp;\u0026plusmn;\u0026thinsp;53.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52(56.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(56.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e15(57.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.887\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40(43.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e29(43.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(42.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALT(U/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.25\u0026thinsp;\u0026plusmn;\u0026thinsp;80.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.50\u0026thinsp;\u0026plusmn;\u0026thinsp;91.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e46.39\u0026thinsp;\u0026plusmn;\u0026thinsp;39.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46(50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(48.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14(53.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46(50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e34(51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12(46.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCR (umol/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.14\u0026thinsp;\u0026plusmn;\u0026thinsp;18.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.43\u0026thinsp;\u0026plusmn;\u0026thinsp;17.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e66.34\u0026thinsp;\u0026plusmn;\u0026thinsp;17.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90(97.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64(97.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e26(100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e༞105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2(3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBUN (mmol/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.00\u0026thinsp;\u0026plusmn;\u0026thinsp;10.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.53\u0026thinsp;\u0026plusmn;\u0026thinsp;11.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81(88.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58(87.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e23(88.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e༞7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(12.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8(12.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(11.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChest CT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83(90.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58(87.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e25(96.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.879\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiopulmonary changes in the elderly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5(7.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(3.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBacterial pneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1(1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOld tuberculosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1(1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSolid pulmonary nodule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.1%0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1(1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious surgical history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eyes\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27(29.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(22.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e12(46.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eno\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(70.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e51(77.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14(53.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight (kg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68.60\u0026thinsp;\u0026plusmn;\u0026thinsp;11.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.71\u0026thinsp;\u0026plusmn;\u0026thinsp;10.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e63.25\u0026thinsp;\u0026plusmn;\u0026thinsp;9.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeight (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168.75\u0026thinsp;\u0026plusmn;\u0026thinsp;6.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e171.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e161.35\u0026thinsp;\u0026plusmn;\u0026thinsp;4.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI(kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.08\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e24.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative time (d)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.420\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative time (d)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.69\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime in hospital (d)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.58\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.12\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14.22\u0026thinsp;\u0026plusmn;\u0026thinsp;4.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntraoperative hemorrhage (ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e190.39\u0026thinsp;\u0026plusmn;\u0026thinsp;83.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e196.76\u0026thinsp;\u0026plusmn;\u0026thinsp;84.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e174.23\u0026thinsp;\u0026plusmn;\u0026thinsp;79.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143.93\u0026thinsp;\u0026plusmn;\u0026thinsp;65.06 (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147.14\u0026thinsp;\u0026plusmn;\u0026thinsp;62.46 (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e134.29\u0026thinsp;\u0026plusmn;\u0026thinsp;76.78 (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.659\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadical resection of hilar cholangiocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e215.00\u0026thinsp;\u0026plusmn;\u0026thinsp;63.03 (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e226.25\u0026thinsp;\u0026plusmn;\u0026thinsp;60.93 (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e192.50\u0026thinsp;\u0026plusmn;\u0026thinsp;69.94 (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.408\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadical cholecystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200.00\u0026thinsp;\u0026plusmn;\u0026thinsp;50.00 (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200.00\u0026thinsp;\u0026plusmn;\u0026thinsp;50.00 (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e267.42\u0026thinsp;\u0026plusmn;\u0026thinsp;58.82 (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e266.40\u0026thinsp;\u0026plusmn;\u0026thinsp;59.36 (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e271.67\u0026thinsp;\u0026plusmn;\u0026thinsp;61.78 (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.848\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRAMPS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106.15\u0026thinsp;\u0026plusmn;\u0026thinsp;27.25 (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.50\u0026thinsp;\u0026plusmn;\u0026thinsp;31.51 (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e120.00\u0026thinsp;\u0026plusmn;\u0026thinsp;10.00 (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic tumor enucleation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116.00\u0026thinsp;\u0026plusmn;\u0026thinsp;33.62 (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140.00 (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e110.00\u0026thinsp;\u0026plusmn;\u0026thinsp;35.59 (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperation time (min)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e193.87\u0026thinsp;\u0026plusmn;\u0026thinsp;49.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197.00\u0026thinsp;\u0026plusmn;\u0026thinsp;52.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e185.92\u0026thinsp;\u0026plusmn;\u0026thinsp;38.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e173.00\u0026thinsp;\u0026plusmn;\u0026thinsp;46.53 (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e172.90\u0026thinsp;\u0026plusmn;\u0026thinsp;53.49 (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e173.29\u0026thinsp;\u0026plusmn;\u0026thinsp;14.33 (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadical resection of hilar cholangiocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e218.92\u0026thinsp;\u0026plusmn;\u0026thinsp;54.85 (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e206.50\u0026thinsp;\u0026plusmn;\u0026thinsp;45.07 (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e243.75\u0026thinsp;\u0026plusmn;\u0026thinsp;71.12 (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.288\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadical cholecystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e239.33\u0026thinsp;\u0026plusmn;\u0026thinsp;35.45 (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239.33\u0026thinsp;\u0026plusmn;\u0026thinsp;35.45 (n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e220.52\u0026thinsp;\u0026plusmn;\u0026thinsp;39.95 (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e218.52\u0026thinsp;\u0026plusmn;\u0026thinsp;39.62 (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e228.83\u0026thinsp;\u0026plusmn;\u0026thinsp;44.01 (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRAMPS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e198.69\u0026thinsp;\u0026plusmn;\u0026thinsp;25.88 (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e209.00\u0026thinsp;\u0026plusmn;\u0026thinsp;25.96 (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e182.20\u0026thinsp;\u0026plusmn;\u0026thinsp;16.67 (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePancreatic tumor enucleation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e195 (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195 (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104.20\u0026thinsp;\u0026plusmn;\u0026thinsp;32.74 (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134.00 (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e96.75\u0026thinsp;\u0026plusmn;\u0026thinsp;32.55 (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eOperative characteristics\u003c/h2\u003e \u003cp\u003eDuring the COVID-19 epidemic, 82% of the patients (75/92) underwent robotic surgery, while the rest were treated using laparoscopic (2/92) or open (15/92) surgery. Operations performed in February 2020 included partial hepatectomy, resection of hilar cholangiocarcinoma, pancreaticoduodenectomy, distal pancreatic resection, and others (including benign and malignant cholecystectomy). All details are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOperations carried out during February 2020 in our Department of Hepatobiliary and Pancreatic Surgical Oncology (n\u0026thinsp;=\u0026thinsp;92)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOperation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eSurgical procedures\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRobotic\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eLaparoscopic\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eOpen\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePartial hepatectomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemihepatectomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMiddle hepatectomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRadical resection of hilar cholangiocarcinoma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRadical cholecystectomy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRAMPS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePancreatic tumor enucleation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOthers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSummary (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (83.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eAbbreviation\u003c/b\u003e: PD: Pancreaticoduodenectomy; RAMPS: Radical antegrade modular pancreatosplenectomy.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePathological characteristics\u003c/h2\u003e \u003cp\u003eAmong all 92 patients, 86 had malignant tumor and six had benign tumor. Pathological results were pancreatic malignant tumor, cholangiocarcinoma, hepatic carcinoma, periampullary carcinoma, and acute benign diseases. All details are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe pathology results of patients in our Department of Hepatobiliary and Pancreatic Surgical Oncology\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathology results\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSubtotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRatio\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePancreatic head carcinoma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePancreatic malignant tumor (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDistal pancreatic cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsulinoma of the pancreatic body\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe pancreatic head IPMN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCarcinoma of the lower middle bile duct\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCholangiocarcinoma (28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHilar cholangiocarcinoma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCarcinoma of gallbladder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHepatic metastatic carcinoma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMalignant tumors of the liver(27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrimary liver cancer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeriampullary carcinoma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeriampullary carcinoma (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHepatic echinococcosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBenign diseases (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGallstone, acute cholecystitis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBile - intestinal anastomosis stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSummary\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalignant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBenign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePostoperative complications\u003c/h2\u003e \u003cp\u003eMajor postoperative complications after hepatobiliary pancreatic surgery included pancreatic fistula, biliary fistula, and bleeding. Only five patients had severe pancreatic fistula after operation. Three cases of biliary fistula occurred, one of which was severe. In addition, 2 of the 92 patients had postoperative bleeding and underwent emergency interventional embolization to return to stable condition. All details are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative outcomes of patients in our Department of Hepatobiliary and Pancreatic Surgical Oncology during February 2020\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePancreatic fistula (n\u0026thinsp;=\u0026thinsp;44)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(72.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(72.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32(72.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(18.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBiliary fistula (n\u0026thinsp;=\u0026thinsp;79)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (96.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (97.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBleeding (n\u0026thinsp;=\u0026thinsp;92)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (97.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (97.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e "},{"header":"Discussion","content":" \u003cp\u003eIn the space of just 3 months, a novel coronavirus\u0026mdash;a family that historically was not viewed as a global health concern\u0026mdash;has become daily headline news worldwide. Studies have shown that the disease, recently named COVID-19 (coronavirus disease 2019, COVID-19) by the World Health Organization (WHO), can induce symptoms including fever, dry cough, dyspnea, fatigue, and lymphopenia in infected patients.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e In more severe cases, infections cause viral pneumonia that can lead to SARS and even death. Since the first report of COVID-19 in December 2019 in Wuhan, China, the outbreak of the disease is has been continuously evolving.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e during the COVID-19 epidemic, many medical resources have been directed to infected patients and many hospitals have closed. As a result, patients with malignant tumors often lose their best treatment opportunities.\u003c/p\u003e \u003cp\u003eHepatobiliary pancreatic tumors are one of the most common cancers.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Patients with liver cancer, gallbladder cancer, or pancreatic cancer have a fast progression and poor prognosis. Our hepatobiliary pancreatic surgical oncology department performed 92 operations in February 1\u0026ndash;29, 2020, during the most serious stage of the epidemic. In this study, we summarized the process management of patients with hepatobiliary pancreatic tumors during the outbreak, and clinical and surgical characteristics and postoperative complications in 92 patients. We believe that our experience will help other clinicians working during the epidemic.\u003c/p\u003e \u003cp\u003eRecent studies have reported that rapid person-to-person transmission of COVID-19 occurs.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e In addition, COVID-19 has been detected in stool samples of patients with abdominal symptoms. However, it is difficult to differentiate and screen patients with typical symptoms. Nevertheless, rapid human-to-human transmission among close contacts is an important feature of the COVID-19 pneumonia.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Hospitals in all provinces and cities across China have taken effective measures to control the spread of COVID-19. However, suspected or uninfected patients with malignant tumors have often been isolated, so these patients cannot receive timely and effective treatments, leading to tumor progression and more non-infectious deaths because of malignant tumors rather than COVID-19 infection. Our department of hepatobiliary and pancreatic surgical oncology was the only surgical oncology department that continued normal operations in the capital of China during the outbreak; we established a relatively reasonable admission process to ensure diagnosis and treatment of patients with malignant tumor in the surrounding area. In addition, we performed surgery in 92 patients from 12 provinces in the north of China during the COVID-19 epidemic. The above admission process from our department may be worth introducing in other large regional hospitals.\u003c/p\u003e \u003cp\u003eThe advantages of minimally invasive surgery were demonstrated during the COVID-19 outbreak.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Robotic surgical systems, which were developed to address the disadvantages of laparoscopy, have made minimally invasive hepatobiliary and pancreatic surgery much more accessible to surgeons.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Among the 92 patients in this study, 93.5% had malignant tumors, requiring timely and effective surgical resection, and 81.5% were subjected to robotic surgery and 2.2% to laparoscopic surgery. Moreover, our department led the drafting and development of an international expert consensus on robotic pancreatic and robotic hepatectomy surgery.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Robotic surgery is as safe as laparoscopic and open surgery, with comparable intraoperative blood loss, length of hospital stay (LOS), overall postoperative complication rate, perioperative mortality, and rate of postoperative pancreatic fistula (POPF) to laparoscopic surgery. Moreover, robotic surgery has a longer operating time, less intraoperative blood loss, and shorter LOS than open surgery, whereas it has a similar overall complication rate, perioperative mortality, and POPF rate.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Taken together, robotic surgery has some advantages in patients with hepatobiliary pancreatic tumor, especially during COVID-19 outbreak, in that it decreases LOS and enhances recovery after surgery.\u003c/p\u003e \u003cp\u003eThe present study had some limitations. First, data came from a single center and were acquired retrospectively. Second, the study was descriptive, so it is unclear whether the results can be extrapolated to other public health events. Third, we only included patients who underwent emergency operations and elective surgeries for hepatobiliary and pancreatic cancers, so it remains to be confirmed whether the approach described is beneficial in patients with benign hepatobiliary and pancreatic diseases.\u003c/p\u003e \u003cp\u003eIn conclusion, we performed surgical resection in 92 patients with hepatobiliary and pancreatic oncology in a department that maintained a normal working regimen during the COVID-19 epidemic. Our standardized hospitalization and treatment processes could prevent cross-infection of patients and still ensure the timely treatment of patients with hepatobiliary and pancreatic cancers. These findings will guide the operation of surgical oncology departments and treatment of patients with hepatobiliary and pancreatic cancers during serious epidemics.\u003c/p\u003e "},{"header":"Abbreviations","content":" \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRed Blood Cell; WBC:White Blood Cell; CRP:C-reactive protein; ALT:Alanine Aminotransferase; AST:Aspartate Aminotransferase; CR:Creatinine; BUN:Blood Urea Nitrogen; BMI:Body Mass Index; PD:Pancreaticoduodenectomy ; RAMPS:Radical antegrade modular pancreatosplenectomy;\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNote\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe test result of the patient with pneumonia was negative for the COVID-19;\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design: Rong Liu, Zhi-Ming Zhao, Xiu-Ping Zhang\u003c/p\u003e\n\u003cp\u003eProvision of study materials or patients: Xiang-Long Tan, Xuan Zhang, Ming-Gen Hu, Cheng-Gang Li, Yuan-Xing Gao, Guo-Dong Zhao\u003c/p\u003e\n\u003cp\u003eCollection and assembly of data: Zhi-Ming Zhao, Xiu-Ping Zhang, Shuai Xu\u003c/p\u003e\n\u003cp\u003eData analysis and interpretation: Zhi-Ming Zhao, Xiu-Ping Zhang, Shuai Xu\u003c/p\u003e\n\u003cp\u003eManuscript writing: Zhi-Ming Zhao, Xiu-Ping Zhang\u003c/p\u003e\n\u003cp\u003eFinal approval of manuscript: All authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used or analyzed during the current study are available from\u0026nbsp;the corresponding author on reasonable request\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study is approved by Ethics Committee of our hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is unavailable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e \u003cspan\u003eHuang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497\u0026ndash;506.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eKsiazek TG, Erdman D, Goldsmith CS, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003;348(20):1953\u0026ndash;66.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eRota PA, Oberste MS, Monroe SS, et al. Characterization of a novel coronavirus associated with severe acute respiratory syndrome. 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One Health approach and Coronavirus Disease 2019. \u003cem\u003eHuman vaccines \u0026amp; immunotherapeutics\u003c/em\u003e 2020: 1\u0026ndash;2.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eWang ZZ, Tang WB, Hu MG, et al. Robotic vs laparoscopic hemihepatectomy: A comparative study from a single center. Journal of surgical oncology. 2019;120(4):646\u0026ndash;53.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eMontalti R, Scuderi V, Patriti A, Vivarelli M, Troisi RI. Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surgical endoscopy. 2016;30(3):1004\u0026ndash;13.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eChoi GH, Chong JU, Han DH, Choi JS, Lee WJ. Robotic hepatectomy: the Korean experience and perspective. Hepatobiliary surgery nutrition. 2017;6(4):230\u0026ndash;8.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eLiu R, Wakabayashi G, Palanivelu C, et al. International consensus statement on robotic pancreatic surgery. Hepatobiliary surgery nutrition. 2019;8(4):345\u0026ndash;60.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eLiu R, Wakabayashi G, Kim HJ, et al. International consensus statement on robotic hepatectomy surgery in 2018. World journal of gastroenterology. 2019;25(12):1432\u0026ndash;44.\u003c/span\u003e \u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19 epidemic, Hepatobiliary pancreatic tumor, Robotic Surgery, Retrospective and descriptive study","lastPublishedDoi":"10.21203/rs.3.rs-40427/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-40427/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e In the battle against COVID-19, most medical resources in China have been directed to infected patients in Wuhan. Thus, patients with hepatobiliary pancreatic tumors who are not suffering from COVID-19 are often not given timely and effective anti-cancer treatments. In this study, we aimed to describe clinical characteristics, treatment, and outcomes of patients with hepatobiliary and pancreatic oncology from our department, which retained normal working during the COVID-19 epidemic. We also sought to formulate a set of standardized hospitalization and treatment processes.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA retrospective and descriptive study was conducted involving patients hospitalized from February 1, 2020, to February 29, 2020 (Return to work after the Spring Festival), at our Department of Hepatobiliary and Pancreatic Surgical Oncology. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe study included 92 patients from 12 provinces in the north of China who underwent surgical resection at our Department of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 epidemic. Robotic surgery was performed on 82% (75/92) of patients, while the rest underwent laparoscopic (2/92) and open surgery (15/92). Eighty-six patients had malignant tumor, and six had emergency benign diseases. Only five patients had severe pancreatic fistula, and three had biliary fistula after operation. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The standardized hospitalization and treatment processes described in this study could prevent cross-infection of patients and still ensure timely treatment of patients with hepatobiliary and pancreatic cancers. These study findings will guide the management of surgical oncology departments and treatment of patients with hepatobiliary and pancreatic oncology during serious epidemics.\u003c/p\u003e","manuscriptTitle":"A Single-Center Retrospective and Descriptive Study of Hepatobiliary and Pancreatic Surgical Oncology during the COVID-19 Epidemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-07-16 15:16:32","doi":"10.21203/rs.3.rs-40427/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3b0512d0-6d27-489e-b701-96b120c0a356","owner":[],"postedDate":"July 16th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":146121,"name":"Cancer Biology"},{"id":146122,"name":"Oncology"}],"tags":[],"updatedAt":"2020-09-04T21:41:22+00:00","versionOfRecord":[],"versionCreatedAt":"2020-07-16 15:16:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-40427","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-40427","identity":"rs-40427","version":["v1"]},"buildId":"omnImTCwR2MFx8CMYfrG7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}