Perioperative Bypassing Agent Therapy for Pulmonary Pleomorphic Carcinoma with Acquired Hemophilia

A 74-year-old man was admitted with lung cancer, and preoperative blood test showed abnormal activated partial thromboplastin time (APTT). Coagulation factor screening and APTT mixing test achieved a diagnosis of acquired hemophilia A (AHA). Bypassing agent therapy was indicated and lobectomy was successfully performed without bleeding complications. APTT returned to normal after the operation without any additional treatment for AHA. The pathogenesis of AHA is still unknown and there is no evidence for hemostatic strategy for AHA patients requiring surgery. This study supports the importance of hemostatic therapy and suggests that malignancy might cause AHA.     

Pedunculated Hepatocellular Carcinoma: Clinicopathologic Study of 18 Surgically Resected Cases

We present the clinical features and outcomes of 18 surgically treated pedunculated hepatocellular carcinomas (P-HCCs). Hepatocellular carcinoma is a notorious, hyperendemic disease in Taiwan. Pedunculated HCC, although not a novel finding, has been recognized and diagnosed early by various imaging modalities. However, the clinicopathologic picture has not been fully clarified, and the prognosis varies in each report. From 1986 to 1998 the clinical features of 18 surgically treated cases of P-HCC were reviewed, including demographics, laboratory data, operative findings, pathologic features, and follow-up results. Factors that may influence the outcomes were also analyzed. Clinical features and outcomes of 414 patients with nonpedunculated hepatocellular (HCC) were summarized for comparison. Of 432 surgical resected hepatocellular carcinomas, 18 (4.2%) were P-HCCs. Larger tumor size, more capsule formation, less vascular invasion, and wider resection margins were significantly prominent in the patients in P-HCC group compared with those in the NP-HCC group. Multivariate stepwise logistic regression analysis revealed that the P-HCC group had significantly larger tumors and wider resection margins. The 1-, 3-, and 5-year survival rates of P-HCC patients were 88.3%, 77.4%, and 45.6%, respectively. A significant difference in survival was found between the P-HCC and NP-HCC groups. P-HCC patients without vascular invasion might have a significantly better survival demonstrated by log-rank analysis stratified by capsular invasion, vascular invasion, resection, and tumor size. We present the clinical features and outcomes of 18 surgically treated pedunculated HCCs. Pedunculated HCCs might have a better survival than conventional HCCs after hepatic resection, especially if there is no vascular invasion.     

肺多形性癌23例临床及病理分析

目的：探讨肺多形性癌（pleomorphic carcinoma,PC）的临床表现、手术方式、病理特点及预后。方法回顾性分析我院胸外科2010年1月～2014年3月收治的23例肺多形性癌患者的临床及病理资料。结果23例患者发病年龄为35～75岁,平均年龄（54±11）岁,其中男16例,女7例,男女比为2．3∶1。17例患者有既往大量吸烟史,吸烟指数为400～1200,平均（688±225）。患者常见首发症状为咳嗽、痰中带血或咯血。术前纤维支气管镜检查难以确诊。23例患者中行肺癌根治术22例,行肿块活检术1例。23例患者中含有恶性上皮成分和多形性成分19例,4例仅含多形性成分,多形性成分中可见 CK 阳性表达。23例患者均获得随访,最长生存时间为18个月,仍存活,中位生存期12个月。结论肺多形性癌好发于中老年男性吸烟患者,免疫组织化学检查有助于明确诊断,外科手术为主要治疗方法。肺多形性癌预后差。     

Prognostic Factors for Surgically Resected N2 Non-small Cell Lung Cancer

Purpose: Non-small cell lung cancers (NSCLCs) with pathologically documented ipsilateral mediastinal lymph node (LN) metastases (pN2) are a broad spectrum of diseases. We retrospectively analyzed prognostic factors for cases of pN2 NSCLC treated by surgical resection.Methods: Clinicopathological data were reviewed for consecutive 121 patients who underwent anatomical pulmonary resection with mediastinal LN sampling or dissection for pN2 NSCLC over a 15-year period.Results: The 5-year survival rate for all patients was 29.9%. Clinical N status, curability, surgical procedure and adjuvant chemotherapy were favorable prognostic factors in univariate analysis, with 5-year survival rates of 35.0% for cN0/1 vs. 17.7% for cN2/3 cases; 33.1% for R0 vs. 14.7% for R1/2 resection; 31.5% for lobectomy vs. 25.0% for bilobectomy and 15.6% for pneumonectomy; and 72.7% with adjuvant chemotherapy vs. 23.8% without adjuvant chemotherapy. Survival did not differ significantly based on gender, age, smoking status, clinical T status, tumor location, histology, skip metastasis, subcarinal LN metastasis, or number of involved N2 levels. In multivariate analysis, adjuvant chemotherapy, R0 resection, and lobectomy emerged as independent favorable prognostic factors.Conclusion: Complete resection using lobectomy and adjuvant chemotherapy are favorable prognostic factors in cases of pN2 NSCLC.     

Correlation of Prognostic Factors and Survival with Classical and Pleomorphic Variants of Invasive Lobular Carcinoma

Abstract: The pleomorphic variant of invasive lobular carcinoma has a worse prognosis than its classical counterpart. To determine if histologically separating invasive lobular carcinoma into either of these variants correlates with other prognostic indicators, we measured the mitotic figure index (number of mitotic figures/100 tumor cells), Ki67 labeling index (Ki67 positive cells/100 tumor cells), intratumoral microvessel density (microvessels/200X field), and the number of positive lymph nodes in 48 patients with invasive lobular carcinoma with a median follow-up of 63 months. There were 27 cases of classical lobular carcinoma (mean age, 58) and 21 cases of pleomorphic variant (mean age, 57). The mitotic figure index and Ki67 labeling index were significantly higher in the pleomorphic variant compared to the classical lobular carcinoma (p = 0.002, and 0.08 respectively). No significant differences in intratumoral microvessel density, number of positive lymph nodes, or age was found between the two histologic types. Relapse free survival was shorter in patients with pleomorphic variant (p = 0.05), but no difference in overall survival was detected (p = 0.47). Among all patients, lymph node status was the best predictor of relapse free (p = 0.001) and overall survival (p = 0.002), although there were no overall survival differences between patients with 0 to 3 positive lymph nodes. Relapse-free and overall survivals were better among patients who had lower indices of microvessel density (p = 0.07 and 0.08 respectively), Ki67 (p = 0.02 and 0.11), and mitotic figures (p = 0.10 and 0.07). By multivariate analysis no additional prognostic information was provided beyond that of the number of positive lymph nodes; except for overall survival, the mitotic figure index provided additional significant information. We conclude that the histologic diagnosis of pleomorphic invasive lobular carcinoma significantly correlates with shortened relapse-free survival, but among all invasive lobular carcinomas axillary nodal status and mitotic figure index provide more prognostic information than histologic subtyping into pleomorphic and classical variants.?     

Autocrine Motility Factor Receptor Expression Implies an Unfavourable Prognosis in Resected Stage I Pulmonary Adenocarcinomas

Background : Pulmonary adenocarcinomas constitute a different histological subtype among the histological subtypes of non small cell lung carcinomas by showing comparably unfavourable rates of prognosis and different immunobiological features. Autonomous motility of tumour cells plays an important role in the regulation of local invasion and distant metastasis of tumour lesions which have great impact on overall survival. AMF (Autocrine motility factor) is a tumour secreted cytokine that stimulates motility during invasion and metastasis via its receptor, AMFR. We conducted an immunohistochemical study to investigate AMFR expression in pulmonary adenocarcinomas and its effect on survival.

Material and methods : We assessed AMFR expression using a monoclonal antibody (3F3A) in a total of 32 surgical specimens with stage I pulmonary adenocarcinomas that underwent curative resection. We analyzed AMFR expression as a possible prognostic factor on survival and its correlations with clinicopathological features. Results : A total of 19 (59.3%) specimens showed AMFR expression. The 3-year survival rates of AMFR positive and AMFR negative patients were 47.3% and 84.6%, respectively, which was a significant difference (P = 0.0197). The univariate predictors of surgical outcome were AMFR expression (P = 0.032) and perineural invasion (P = 0.038). However, multivariate analysis revealed AMFR expression (P = 0.045) as the only independent prognostic factor. Conclusions : AMFR expression predicts an unfavourable surgical outcome in patients with stage I pulmonary adenocarcinomas.     

Adenoid Cystic Carcinoma ex Pleomorphic Adenoma of the Parotid Gland

There is a considerable variation in the histologic subtype of epithelial malignancies among carcinoma ex pleomorphic adenomas (CXPA) and virtually any known carcinoma entity can develop. To our knowledge, adenoid cystic carcinoma (AdCC) ex PA is quite rare despite the fact that de novo AdCC is the fourth most common salivary gland malignancy. We describe a new case of AdCC ex PA in the parotid gland of a 62 year-old woman. In our patient, there was a short interval of time between parotidectomy and local recurrence and rapid development of distant metastases. Although most of the reported cases are considered low-grade, evidence is presented here that AdCC can take the form of a high-grade malignancy in PA.     

Retrospective Analysis of Predictive Factors for Recurrence After Curatively Resected Papillary Thyroid Carcinoma

Purpose This retrospective study analyzes the predictive factors after curative surgery for papillary thyroid carcinoma (PTC).Methods We analyzed 386 patients who underwent a curative operation for PTC in our hospital between 1977 and 1997, subject to the inclusion criteria.Results According to univariate analysis, pathological lateral cervical lymph node involvement (P < 0.0001), dedifferentiation of the tumor (P < 0.002), male sex (P < 0.0001), a large tumor (P < 0.005), and an age of over 50 years (P < 0.05) were significant factors. Cox’s proportional hazard model showed that a man (P < 0.05), aged over 50 years (P < 0.05), who had a large primary tumor (P < 0.05) with dedifferentiation (P < 0.05), and pathological lateral cervical lymph node metastasis (P < 0.005) was more likely to have recurrence of PTC.Conclusions Determining whether lymph node metastasis exists could be useful for predicting recurrence in patients who have undergone curative resection of PTC.     

Prognostic Factors for Renal Cell Carcinoma: A Multivariate Analysis of 320 Cases

Background We performed a multivariate analysis of clinical variables in 320 patients with renal cell carcinoma to identify important prognostic factors for long-term survival. Methods We retrospectively reviewed the medical records of 320 patients who presented with renal cell carcinoma. Survival curves were calculated by the Kaplan-Meier method and statistical differences were determined by the log-rank test. Significant prognostic factors were evaluated by Cox's multivariate proportional hazard model. Results The median follow-up period was 29 months. The overall survival rates at 1, 5, and 10 years were 90.0%, 77.6%, and 69.9%, respectively. Seventeen of the 19 prognostic factors evaluated were shown to be significant by the log-rank test: patient age, sex, performance status, body temperature, erythrocyte sedimentation rate (ESR), levels of hemoglobin, a₂-globulin, C-reactive protein, fibrinogen, immunosuppressive acidic protein (IAP), size or involvement of tumor (T classification), regional lymph node involvement (N classification), extent of metastasis (M classification), pathologic grade, tumor cell type, mode of tumor infiltration, and the modality of treatment (curative surgery). Among them, the body temperature, ESR, a₂-globulin, fibrinogen, IAP, and mode of tumor infiltration were excluded from multivariate analysis because of missing data. Curative surgery was also excluded because it is a treatment modality and different from the other variables which are clinical or pathologic characteristics. From the remaining 10 variables, multivariate analysis showed that age (P = 0.0389), N classification (P = 0.0289), and M classification (P <0.0001) were important and independent prognostic factors for long survival. Conclusion This analysis showed that age, N classification, and M classification were the most important factors predicting long-term survival of patients with renal cell carcinoma.     

Clinical Impacts of EGFR Mutation Status: Analysis of 5780 Surgically Resected Lung Cancer Cases

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Carcinoma ex Pleomorphic Adenoma of the Nasal Cavity

Background  

Carcinoma ex pleomorphic adenoma (CXPA) is a malignant epithelial neoplasm arising in a benign mixed tumor (i.e., pleomorphic adenoma or PA); it accounts for approximately 3–4% of all salivary gland neoplasms. CXPA is exceedingly rare in the nasal cavity, with only three cases previously documented.     

Myoepithelial Carcinoma Ex Pleomorphic Adenoma of the Maxillary Sinus: A Case Report and Review of Literature

Myoepithelial carcinoma ex pleomorphic adenoma is defined as a malignant epithelial neoplasm arising from a primary or recurrent benign pleomorphic adenoma. This type of tumor comprises 3.6% of all salivary gland tumors and 12% of malignant ones. Clinically, it most commonly presents as a firm mass in the parotid gland. The development of this neoplasm in the sinonasal and nasopharyngeal regions is extremely rare and only few cases are reported in the literature. The prognosis of myoepithelial carcinoma is variable. Marked cellular pleomorphism, high mitotic rate, and high proliferative activity correspond to a poor prognosis. In this article, the authors report the histopathological features of a clinical case of a 64-years-old patient with a large median maxillary neoplasm diagnosed as myoepithelial carcinoma/ex-pleomorphic adenoma. The tumor was resected and subjected to secondary reconstruction using a revascularized free fibula flap. The myoepithelial derivation of neoplastic cells was demonstrated by immunohistochemical positivity for S-100 protein (strong and diffuse), cytokeratin 14 (strong and diffuse), and GFAP (focal).     

肺多形性癌的临床处理及文献分析

目的探讨肺多形性癌(pleomorphic carcinoma,PC)的临床表现、手术方法及预后,以提高其诊断和治疗的有效性。方法回顾性分析四川大学华西医院自2006年1月至2011年8月期间收治7例肺多形性癌患者的临床资料,男5例,女2例,男女比例为2.5∶1.0;平均年龄58.85(43～69)岁。并使用PubMed检索系统,检索关键词为Pulmonary pleomorphic carcinoma surgery,复习2005～2011年报道有完整资料的8例患者的文献,其中男7例,女1例,男女比例7︰1;平均年龄70.25(51～79)岁。15例患者均行手术治疗并行系统淋巴结清扫术。结果本组资料平均发病年龄64.93(43～79)岁;15例患者中,男12例,女3例,男女比例为4∶1;主要症状多为咳嗽,痰中带血及咯血,胸痛;病理诊断均为多形性癌。本院7例患者中,梭形细胞癌伴鳞癌3例,梭形细胞癌伴腺癌2例,梭形细胞癌伴大细胞癌和腺癌2例;截至随访时有3例术后死亡,最长生存时间49个月,4例恢复良好。检索文献资料的8例患者中,梭形细胞癌伴鳞癌4例,梭形细胞癌伴腺癌1例,梭形细胞癌伴大细胞癌和鳞癌1例,梭形细胞癌伴腺癌和鳞癌2例;截至随访时有5例术后死亡,最长生存时间22个月,3例恢复良好。结论肺多形性癌极为少见,积极手术治疗可取得较好的疗效。     

包皮环切术后发生阴茎鳞状细胞癌17例报道

目的:分析包皮环切术后发生的阴茎癌的诊治。方法:回顾性分析我院1997年1月~2004年12月行包皮环切术后1个月~16年发生阴茎癌17例患者的临床资料。结果:本组患者中术后1~12个月发现阴茎癌者11例,术后3~16年发现者6例;16例行阴茎部分切除术+腹股沟淋巴结活检术,1例行扩大包皮环切术后复发相继行阴茎部分切除、全切术。复发的1例死亡,其余16例存活至今。结论:成年人行包皮环切术后仍有发生阴茎癌可能,对伴有包皮炎症、溃疡等病变的患者行包皮环切术应常规行病理检查,术后需密切随访,阴茎部分切除术是治疗早期阴茎鳞状细胞癌有效的方法,术中有必要行前哨淋巴结活检。     

Interstitial Fluid Pressure Correlates Clinicopathological Factors of Lung Cancer

Purpose: Solid tumors show increased interstitial fluid pressure (IFP), which correlates to a number of pathophysiological features of tumors. There have been no reports on the usefulness of measuring IFP in lung cancer. The aim of this study was to examine the relationship between IFP and the clinicopathological characteristics of lung cancer.Methods: IFP was measured prospectively in 215 patients with 219 lesions showing solid or part-solid appearance. Four patients with double lung cancer were excluded from the analysis, resulting in 211 patients with lung cancer being analyzed for the correlation between IFP and computed tomography (CT) appearance, size, Tumor-node-metastasis (TNM) classification, maximal standardized uptake value (SUVmax), histological type, tumor grade, pleural and vessel invasion, Ki-67 index, and recurrence-free survival (RFS).Results: The mean IFP was 8.5 mmHg; IFP was significantly correlated with the tumor size, SUVmax, TNM, vessel and pleural invasion, and Ki-67 index. Low IFP was associated with a better RFS compared to high IFP. Multivariate analysis did not select IFP as independent prognostic factor. In subgroup analysis of patients with adenocarcinoma, IFP was selected as independent one.Conclusions: IFP correlates clinicopathological factors of lung cancer. IFP might be used as a prognostic factor for lung cancer.     

Molecular Features and Prognostic Factors of Pleomorphic Xanthoastrocytoma: A Collaborative Investigation of the Tohoku Brain Tumor Study Group

Pleomorphic xanthoastrocytoma (PXA) is a rare glial tumor, however, its histological differentiation from high-grade gliomas is often difficult. Molecular characteristics may contribute to a better diagnostic discrimination. Prognostic factors of PXA are also important but few relevant reports have been published. This study investigated the molecular features and prognostic factors of PXAs. Seven university hospitals participated in this study by providing retrospective clinical data and tumor samples of PXA cases between 1993 and 2014. Tumor samples were analyzed for immunohistochemical (IHC) neuronal and glial markers along with Ki67. The status of the BRAF and TERT promoter (TERTp) mutation was also evaluated using the same samples, followed by feature extraction of PXA and survival analyses. In all, 19 primary cases (17 PXA and 2 anaplastic PXA) were included. IHC examination revealed the stable staining of nestin and the close association of synaptophysin to NFP. Of the PXA cases, 57% had the BRAF mutation and only 7% had the TERTp mutation. On univariate analysis, age (≥60 years), preoperative Karnofsky performance status (KPS) (≤80%), and marked peritumoral edema were significantly associated with progression-free survival (PFS). No independent factor was indicated by the multivariate analysis. In conclusion, PXA was characterized by positive nestin staining and a few TERTp mutations. The neuronal differential marker and BRAF status may help in diagnosis. Patient age, preoperative KPS, and marked perifocal edema were associated with PFS. The present study is limited because of small number of cases and its retrospective nature. Further clinical study is needed.     

Co-expression of Myoepithelial and Melanocytic Features in Carcinoma Ex Pleomorphic Adenoma

The presence of melanin pigment and melanocytic markers expression have been rarely reported in salivary gland tumors. Herein, two cases of carcinoma arising in pleomorphic adenoma of the parotid gland and showing diffuse expression of myoepithelial and melanocytic markers are described. The clinical-pathological clues useful in the differential diagnosis with melanoma are discussed. In addition, a review of the pertinent literature is also proposed, discussing the pathologic mechanisms potentially involved in this phenomenon.Supplementary InformationThe online version of this article (10.1007/s12105-021-01299-4) contains supplementary material, which is available to authorized users.     

Comparison of Surgically Resected Polypoid Lesions of the Gallbladder to their Pre-operative Ultrasound Characteristics

Background  Polypoid lesions of the gallbladder (PLG) have been a common finding on ultrasound examinations of the abdomen and are more prevalent since our use of equipment incorporating pulse shaping increased bandwidth, and enhanced phase use for image reconstruction began in 1996. Our study correlates the pre-operative ultrasonographic findings of these lesions to the surgically resected specimen with specific regard to identifying neoplastic polyps. Methods  A retrospective review was performed of 130 patients who had a pre-operative ultrasound of the gallbladder and subsequently underwent cholecystectomy between August 1996 and July 2007 at the Mayo Clinic Rochester. Results  Seventy-nine pseudopolyps (cholesterol polyps, inflammatory polyps, and adenomyomas) and 15 neoplastic polyps were identified on histopathologic analysis. However, 36 patients (27%) did not have a PLG upon histopathologic analysis. Thirty-one polyps had suspicious ultrasonographic characteristics for neoplastic changes. Twenty-nine were ≥10 mm, 12 had vascularity, and one demonstrated invasion. Of these, there were 23 pseudopolyps and six true polyps with neoplastic changes on final pathology (four dysplastic adenomas and two adenocarcinomas). Three asymptomatic polyps ≤10 mm (4%) in maximum diameter based on pre-operative ultrasound imaging (US) had neoplastic changes at pathology (two dysplastic adenomas and one adenocarcinoma). Several statistically significant risk factors were identified that increased the likelihood for malignancy in a PLG: history of primary sclerosing cholangitis (PSC), local invasion, vascularity, and ≥6 mm maximum diameter based on pre-operative US. Of PLGs ≤10 mm, 7.4% were neoplastic. Twenty-five patients were followed up with at least two serial ultrasound examinations. Of these, seven demonstrated polyp growth. None of these specimens demonstrated neoplastic changes. The positive predictive value (PPV) and negative predictive value (NPV) for ultrasound diagnosing neoplastic changes based on current criteria was 28.5% and 93.1%, respectively, with a false negative rate of 5.0%. Expanding the criteria to include cholecystectomy for PLGs ≥ 6 mm changes the positive predictive value and negative predictive value to 18.5% and 100%, respectively, with a false negative rate of 0%. Conclusion  Histopathologic analysis of polypoid lesions of the gallbladder continues to be the gold standard to identify malignancy. Ultrasound has been used extensively in the pre-operative management of these lesions, but modern ultrasound techniques are unable to differentiate between benign and malignant PLGs with any certainty. We recommend that strong consideration be given to surgical resection of PLGs ≥ 6 mm based on pre-operative US due to the significant risk of neoplasm. Additionally, PLGs in all patients with PSC, any patient in whom diligent long-term follow-up cannot be completed, and lesions that demonstrate growth, vascularity, invasion, or are symptomatic require cholecystectomy. Presented at SSAT at the DDW     

手术方式与胆囊癌预后的关系分析

目的　研究影响胆囊癌预后的因素 ,探讨手术方式与胆囊癌预后的关系。方法　回顾性分析我科自 1995年 6月 - 2 0 0 1年 6月手术治疗的 5 6例胆囊癌的临床资料 ,进行统计学分析。结果5 6例患者中男性 2 0例 ,女性 36例 ,男∶女为 1∶1.5 6。 34例合并胆囊结石。腹痛 (83.9% )和黄疸(41.1% )是主要的症状。 30例患者 (包括NevinⅡ期 5例 ,Ⅲ期 3例 ,Ⅳ期 4例 ,Ⅴ期 18例 )获得根治性切除或扩大的根治性切除 ,11例NevinⅤ期施行姑息性切除 ,行剖腹探查活检及改善症状的姑息手术者 15例。统计学分析显示术后存活时间与以下 3个因素显著相关 :手术方式、Nevin分期、是否合并胆囊结石 ;但与以下 6个因素关系不显著 :年龄、性别、病理类型、肿瘤细胞分级、术前血清胆红素、肿瘤涉及胆囊部位个数。将根治性手术以Nevin分期归类 ,Ⅱ期根治术后患者全部存活 ,Ⅲ -Ⅴ期根治术、Ⅴ期姑息性切除、Ⅴ期活检及减轻症状手术的术后生存时间之间存在统计学差别。结论　随着胆囊癌病理分期的增加 ,相应各期根治性手术的术后生存时间逐渐缩短。对于NevinⅤ期的患者 ,施行根治性切除者的术后生存时间长于姑息性切除者 ,而后者术后存活比活检及减轻症状手术者长。根治性手术仍然是胆囊癌患者术后获得较长生存的唯一手段     

胰腺癌患者术后并发肺部感染的危险因素分析

目的:研究胰腺癌患者术后并发肺部感染的危险因素。方法:回顾性分析2009年1月—2018年12月沧州市人民医院收治的356例经手术治疗的胰腺癌患者,收集胰腺癌患者术后感染情况的临床资料:年龄、性别、吸烟史、高血压病病史、高脂血症病史、麻醉方式、手术方式、手术时间、术中出血量、术中输血量、腹腔引流管留置时间、体重指数(BMI)等,采用单因素及多因素Logistic回归分析胰腺癌患者术后并发肺部感染的危险因素。结果:356例胰腺癌患者术后发生感染43例,感染率12.07%。单因素分析结果显示:年龄、吸烟史、麻醉方式、手术方式、手术时间、腹腔引流管留置时间、BMI与胰腺癌患者术后并发肺部感染有关(P 0.05)。Logistic回归分析结果显示年龄≥60岁、术前有吸烟史、麻醉方式、手术方式、手术时间≥4 h、腹腔引流管留置时间≥10 d、BMI≥24 kg/m~2是胰腺癌患者术后发生肺部感染的危险因素。结论:高龄、术前吸烟史、静脉麻醉、胰十二指肠切除术、手术时间长、腹腔引流管留置时间长、BMI高是胰腺癌患者术后并发肺部感染的危险因素。