ObjectiveTo discuss diagnosis and treatment of peritoneal metastasis from colorectal cancer. MethodThe literatures about methods of diagnosis and treatment of peritoneal metastasis from colorectal cancer at home and abroad were reviewed. ResultsDiagnosis methods of peritoneal metastasis from colorectal cancer were constantly updated, mainly including hematology, immunology, and imaging methods. Prophylactic treatment mainly included infusion chemotherapy and postoperative systemic chemotherapy. The resection of primary tumor and cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy were performed for the patients diagnosed as peritoneal metastasis from colorectal cancer. ConclusionsThere is still no gold standard for diagnosis of peritoneal metastasis from colorectal cancer. Comprehensive assessment and comprehensive treatment would be performed, so that effect of treatment might be improved.
Objective To investigate the clinical and pathological factors associated with simultaneity peritoneal metastasis of colorectal cancer. Methods Clinical data of 1 593 patients with simultaneity peritoneal metastasis of colorectal cancer who treated in Suqian People’s Hospital and Nanjing Drum Tower Hospital from 2010-2014 were collected to analyze the risk factors of simultaneity peritoneal metastasis of colorectal cancer. Results There were 40 patients (2.5%) suffered form simultaneity peritoneal metastasis of the 1 593 patients with colorectal cancer. The result of univariate analysis showed that, age, diameter of tumor, level of carcino-embryonic antigen (CEA), level of CA19-9, level of CA-125, T staging, differentiation, pathological type, and combining with diabetes were risk factors of simultaneity peritoneal metastasis of colorectal cancer, that incidence rates of simultaneity peritoneal metastasis in patients with ≥ 65 years old, diameter ≥ 5 cm, increase of CEA, CA19-9, and CA-125, later staging of T staging, poorly differentiated, signet ring cell carcinoma/mucinous adenocarcinoma, and combining with diabetes were higher (P<0.05). The result of logistic regression showed that, level of CA19-9, level of CA-125, T staging, combining with diabetes, differentiation, and pathological type were the risk factors of simultaneity peritoneal metastasis of colorectal cancer, that incidence rates of simultaneity peritoneal metastasis in patients with increase of CEA and CA-125, later staging of T staging, poorly differentiated (compared with well differentiated), mucinous adenocarcinoma (compared with adenocarcinoma), and combining with diabetes were higher (P<0.05). Conclusion Increase of CEA and CA-125, T staging, poorly differentiated, mucinous adenocarcinoma, and combining with diabetes are independent risk factors for simultaneity peritoneal metastasis of colorectal cancer.
Objective To detect expressions of CD31 and D2-40 in patients with simultaneous colorectal cancer with peritoneal metastasis and investigate their correlation between them. Method The expressions of CD31 and D2-40 protein in these 59 cases (there were 19 and 40 patients with or without peritoneal metastasis, respectively) of colorectal cancer were detected by immunohistochemical MaxVision method. Results ① The positive rates of CD31 and D2-40 protein expression in the colorectal cancer tissues with or without peritoneal metastasis were significantly higher than those of the normal colonic tissues (P<0.05), but which had no significant differences between the colorectal cancer tissues with or without peritoneal metastasis (P>0.05). ② The CD31 microvessel density (CD31-MVD) and D2-40 lymphatic microvessel density (D2-40-LMVD) in the colorectal cancer tissues with peritoneal metastasis were significantly higher than those of the normal colonic tissues (P<0.05) and the colorectal cancer tissues without peritoneal metastasis (P<0.05). ③ The CD31-MVD and D2-40-LMVD were not associated with all the clinicopathologic characteristics of the colorectal cancer patients without peritoneal metastasis (P>0.05), but which in the poorly differentiated adenocarcinoma and mucinous and signet ring cell carcinomas patients with peritoneal metastasis were significantly higher than those of the other types (P<0.05) and were not associated with the age, gender, and diamter of the tumor of it (P>0.05). ④ There was a positive correlation between the CD31-MVD and the D2-40-LMVD in the colorectal cancer patients with or without peritoneal metastasis (r=0.342, P=0.012; r=0.119, P=0.008). Conclusions CD31-MVD and D2-40-LMVD in colorectal cancer patients with peritoneal metastasis highly express and has a positive correlation, which means that they might have a certain relationship with peritoneal metastasis. There may be some common regulation way and collaboratively participate peritoneal metastasis of colorectal cancer.
Objective To explore feasibility and efficacy of laparoscopic microsurgery by transanal glove port for excision of rectal tumor. Methods Seventeen patients with rectal tumor underwent laparoscopic microsurgery by transanal glove port for local excision of rectal tumor were chosen from March 2015 to March 2016. This device was constructed by using a incision protective sleeve and standard surgical glove. The laparoscopy was used as lighting equipment. The ultrasonic scalpel, operation forceps and lens were separately inserted into the fixed sheath card from the 3 finger gloves. Results The operations of 17 cases were completed successfully. The operative time was 35–90 min with an average 54 min. The closed glove access time was 11 to 26 min with an average 18 min. The diameter of tumor was 1.4–3.5 cm with an average 2.4 cm. The results of postoperative pathology included 8 cases of villos adenemas, 3 cases of high-grade intraepithelial neoplasia, 1 case of low-grade intraepithelial neoplasia, 3 cases of carcinoid , and 2 cases of adenocarcinoma. All resection margins were negative. No infection, intestinal fistula, bleeding, and other complications were found. The hospital stay was 4–9 d with an average of 5 d. No recurrence was found during a follow-up of 1–6 months. Conclusions The preliminary results of limited cases in this study show that laparoscopic microsurgery by transanal glove port for excision of rectal tumor is easy, safe, and effective. It also provides a new choice for individualized comprhensive treatment of rectal tumor.
Objective To understand bariatric-metabolic surgery and explore it’s effects on all systems of body. Method The literatures relevant bariatric-metabolic surgery at home and abroad were reviewed and analyzed. Results The bariatric-metabolic surgery continued to evolve, which had undergone the changes of the open and minimally invasive therapeutic pathways, it’s effect of weight reduction was remarkable and had a low incidence of postoperative complications. But there was still no " gold standard” for selection of operation method. The bariatric-metabolic surgery affected the changes of all the systems of the body, could cure or improve the obesity related diseases. Conclusions With minimal invasion and precision of bariatric-metabolic surgery, although it’s complications is less and less, there are still some problems. We need to fully evaluate by multidisciplinary, pay attention to physiological and psychological factors, adopt scientific nutrition management, promote benign development of bariatric-metabolic surgery.
Objective To explore the advantage of transection the cervical muscles at sternal end and flip fixed in therapeutic bilateral huge thyroid surgery. Methods The transection of the cervical muscles at sternal end and flip fixed in 53 cases was observation group， 44 cases of the neck white line incision thyroid surgery completed for the control group. The completion of the surgery by the same group of physicians. The operative time， operation field of exposing effect， amount of bleeding in operation， postoperative complications， and postoperative drainage volume were compared between two groups. Results There was no statistically differences of sex， age， disease composition， and tumor size between two groups （P＞0.05）. Operative time， amount of bleeding， and postoperative drainage volume in observation group were shorter （less） than that in control group （P＜0.01）. The postoperative complication rate in observation group was lower than that in control group（P=0.04）. Surgical field exposure in observation group was better than that in control group （P＜0.01）. Conclusions The huge bilateral thyroid surgery with the sternal end approach is feasible and simple. The operation field exposure is better than the white line neck incision， complications after operation is less. It is worthy of clinical application.
Objective To explore clinicopathologic features and prognostic factors of different pathological types of advanced gastric cancer. Methods The clinicopathologic data of 98 patients with advanced gastric cancer who underwent radical gastrectomy in Suqian People’s Hospital, Nanjing Drum Tower Hospital Group, Affiliated to Nanjing University Medical School in 2011 were analyzed retrospectively. There were 53 cases of gastric adenocar-cinoma, 30 cases of mucinous adenocarcinoma, and 15 cases of signet ring cell carcinoma among them. The differences of clinicopathologic characteristics and prognosis were compared among different pathological types of advanced gastric cancer. Results ① There were no significant differences in terms of the gender, age, nerve invasion, and degree of differentiation among the three groups (P>0.05), there were significant differences in terms of the tumor diameter, tumor location, radical surgery type, regional lymph node metastasis, lymphatic cancer embolus, depth of invasion, and pTNM stage among the three groups (P<0.05). ② The results of the univariate analysis showed that the prognosis of gastric adenocarcinoma was associated with the tumor diameter, tumor location, radical surgery type, regional lymph node metastasis, depth of invasion, or pTNM stage (P<0.05); the prognosis of mucinous adenocarcinoma was associated with the radical surgery type, regional lymph node metastasis, or pTNM stage (P<0.05); the prognosis of signet ring cell carcinoma was associated with the regional lymph node metastasis, depth of invasion, and pTNM stage (P<0.05). ③ The results of the Cox multivariate analysis showed that the tumor location (P=0.016), regional lymph node metastasis (P=0.042), invasion depth (P=0.021), and pTNM stage (P=0.009) were the independent risk factors of prognosis for the gastric adenocarcinoma; the regional lymph node metastasis was the independent risk factor of prognosis for gastric mucinous adenocarcinoma (P=0.000); the tumor invasion depth (P=0.032) and regional lymph node metastasis (P=0.002) were the independent risk factors of prognosis for signet ring cell carcinoma. ④ The follow-up time was 60 months. The median follow-up time was 32 months in the gastric adenocarcinoma, 43 months in the mucinous adenocarcinoma, 23 months in the signet ring cell carcinoma, the 5-year accumulated survival rate was 30.2%, 23.3%, and 26.7% respectively. The comparison of survival curves of these three different pathological types of gastric cancer had no significant difference (P=0.131). Conclusion Clinical and pathological features of patients with different pathological types of advance gastric cancer present some differences, and prognostic factors are also different, but regional lymph node metastasis is a common prognostic factor for different pathological types of advanced gastric cancer.