Objective To assess the value of vascular endothelial growth factor (VEGF) expression in the prognosis of esophageal cancer. Methods PubMed and EMbase were searched for collecting retrospective cohort studies on the correlation between VEGF expression and prognosis of esophageal cancer, and relevant articles were also retrieved from inception to June, 2012. Two reviewers independently screened the literature, extracted the data, and evaluated the quality. Then the meta-analysis was performed by using RevMan5.0 software, and the publication bias of literature was evaluated by means of Begg’s funnel plot and Egger’s method. Results Finally 10 cohort studies involving 811 patients were included. The meta-analysis showed that, patients with high level of VEGF had poor overall survival (HR=1.55, 95%CI 1.25 to 1.91). The results of subgroup analyses including VEGF subtype, critical value of VEGF and source of patient showed that: a) there was no correlation between patient’s prognosis and high level of VEGF-C; b) The high level of VEGF subtype in cancer tissue indicated a higher risk of death when the critical value was 10%, while it was not related to the prognosis when the critical value was 30%; and c) The high level of VEGF in cancer tissue was more valuable to predict the prognosis of esophageal cancer for Chinese patients rather than non-Chinese patients. Conclusion The level of VEGF’s expression in cancer tissue is valuable to predict the prognosis of esophageal cancer.
Objective To investigate the early diagnosis and treatment methods of primary duodenal papilla carcinoma. Methods The medical records of 54 patients with primary duodenal papilla adenocarcinoma underwent operation between January 2002 and December 2008 were reviewed. Results Thirty seven cases received fiberduodenoscopy and 35 cases received ERCP, and the accuracy of them were both 100%. Forty four patients received duodenopancreatectomy and 10 patients received jaundice-reducing operation. The 1-, 3-, and 5-year cumulation survival rate was 68%, 50%, and 29%, respectively. Conclusions Fiberduodenoscopy and ERCP are the effective diagnostic methods for duodenal papilla carcinoma. Early diagnosis and early rational radical operation are essential for successful treatment of duodenal papilla carcinoma.
【Abstract】ObjectiveTo study the influence of clinicopathologic characteristics and surgical treatment of gastric cancer on patients’ survival rate.MethodsFrom Apr.1994 to Aug.2005, the data of 759 gastric cancer patients concerning surgical treatment, pathological diagnosis and outcome were collected. Retrospective analysis of the results was made, 3-year and 5-year survival rates were calculated by Kaplan-Meier curve method, univariate analysis was done through Logrank and multiple factors comparison through Cox regression analysis, and follow-up duration was 4－131 months.ResultsSingle factor analysis indicated that age,tumor location,diameter of tumor, Borrmann type, type of histology, TNM stage, depth of infiltration, lymph node metastasis, liver metastasis, peritoneal dissemination, blood of transfusion during operation, extent of the radical cure of the tumor and excision techniques were significantly influential factors for the prognosis of patients. Cox regression analysis showed that tumor location, diameter of tumor,depth of infiltration, lymph node metastasis,liver metastasis, TNM stage, peritoneal dissemination, blood transfusion during operation, extend of the radical cure of the tumor and excision techniques were independent factors influencing the postoperative survival rate.ConclusionIndependent factors influencing the postoperative survival rate include tumor location, diameter of tumor, lymph node metastasis, infiltration depth of the tumor, pathological classification, liver metastasis, peritoneal dissemination, and TNM stage, extent of the radical cure of the tumor, lymphanodectomy techniques and blood transfusion during operation are also important factors.
近年国内肝移植发展迅猛，已自然形成几大中心，在手术方式上也自有特色［1］。除转流条件下的经典肝移植，还有非转流条件下的经典肝移植及背驮式肝移植。各种手术方式都有其长处及不足之处，主要取决于术者经验及习惯。一般来讲背驮式对全身循环干扰较小，但切除病肝有时较困难，特别对乙肝肝硬变患者，因肝周的炎症、纤维化，肝组织常将肝后下腔静脉包绕，分离极为困难，出血较多。近年欧美及国内一些中心主张非转流下的经典肝移植［2，3］，优点是可减少手术时间，避免一些因转流产生的并发症，但缺点是可能造成循环不稳定及肾功损害，因此要求选择合适的病例，方能安全手术。我院仍习用转流条件下的肝移植术，并在此基础上提出了先转流后游离肝脏的手术方法，取得满意效果，现介绍讨论如下。
To evaluate the present status of treatment of chronic pancreatitis, 116 consecutive patients with chronic pancreatitis during the last decade (1986～1996) have been surveyed retrospectively. The clinical date has been analized statisticaly. Etiology: biliogenic 56 cases (48.3%), alcoholic 17 (14.6%), idiopathic 34 (29.3%) and other 9 cases (7.8%). Better result was achieved in surgical treatment group (81 cases) than in conservative group (35 cases), pain free: 65.5% vs 33.3%. The accumulated five-year survival rate was 56.3%, 92.2% and 78.1% in alcoholic, billiogenic and idiopathic type of chronic pancreatitis respectively. Morbidity and mortality of diarrhea and diabetes mellitus increased at followup. The authors conclude that the chronic pancreatitis patients associated with obstruction of biliopancreatic duct should undergo operation early and will ameliorate abdominal pain.
Abstract： Objective To evaluate the clinical significance of bilateral supraclavicular lymph node dissection after esophagectomy for patients with intrathoracic esophageal carcinoma. Methods A total of 197 patients with esophageal carcinoma but no obvious supraclavicular lymph node metastasis who underwent esophagectomy in Zhongshan Hospital of Xiamen University from March 1997 to September 2004 were included in this study. All the patients were divided into 2 groups， the control group and the study group. In the control group (non-supraclavicular lymphadenectomy group)， there were 96 patients including 62 males and 34 females with their age of 40-69 （55.2±3.1） years， who received 2-field lymphadenectomy (intrathoracic lymphatic drainage area and left paracardial lymph nodes) without supraclavicular lymph node dissection. In the study group (supraclavicular lymphadenectomy group)， there were 101 patients including 68 males and 33 females with their age of 41-68 （53.8±4.5） years， who received 3-field lymphadenectomy including intrathoracic lymphatic drainage area， left paracardial lymph nodes and bilateral supraclavicular lymph node dissection. Postoperative survival rate， lymph node metastasis rate， anastomotic site recurrence rate， and long-term supraclavicular lymph node metastasis rate were compared between the 2 groups. Results The overall 5-year survival rate of all the patients was 39.59% （78/197）. There was no statistical difference in 5-year survival rate between the 2 groups ［37.50％ （36/96） vs. 41.58％（42/101）， P＞0.05］. However， the 5-year survival rate of the patients with esophageal carcinoma in the upper third of the esophagus in the study group was significantly higher than that of the control group ［38.10％（8/21） vs. 29.17％ （7/24）， P＜0.05］. The intrathoracic lymph node metastasis rate （14.58% vs. 12.87%）， abdominal lymph node metastasis rate （6.25% vs. 7.92%）and anastomotic site recurrence rate （5.20% vs. 5.94%）of the control group and study group were not statistically different （P＞0.05）. However， long-term supraclavicular lymph node metastasis rate of the study group was significantly lower than that of the control group （2.97％ vs. 8.33％， P＜0.05） Conclusion Bilateral supraclavicular node dissection can significantly increase postoperative survival rate and decrease long-term supraclavicular lymph node metastasis rate of patients with esophageal carcinoma in the upper third of the esophagus.
Objective To evaluate the safety，efficacy，short- and long-term clinical outcomes of complete video-assisted thoracoscopic surgery （VATS） lobectomy for non-small cell lung cancer （NSCLC）. Methods Clinical data of231 consecutive patients with NSCLC who underwent complete VATS lobectomy in the First Affiliated Hospital of NanjingMedical University between June 2006 and March 2011 were retrospective analyzed. There were 132 male and 99 femalepatients with their age of 15-81 （59.51±11.90） years. Preoperative cancer staging wasⅠa in 149 patients，Ⅰb in 50 patients，Ⅱa in 14 patients，Ⅱb in 13 patients and Ⅲa in 5 patients. There were 152 patients with adenocarcinoma，41 patients with squamous carcinoma，23 patients with bronchioalveolar carcinoma，5 patients with adenosquamous carcinoma，4 patients with large cell carcinoma，and 6 patients with other carcinoma. Follow-up data were statistically analyzed，and short-and long-term survival rates were calculated. Results No perioperative mortality was observed. Operation time was 60-370（199.14±51.04） minutes，and intraoperative blood loss was 10-2 300 （168.19±176.39） ml. Thirty-seven patients had postoperative complications including air leak，pulmonary infection，atelectasis，arrhythmia，subcutaneous emphysema andothers，who were all cured after conservative treatment. Mean number of dissected lymph nodes was 11.14±5.49，and meannumber of explored nodal stations was 3.66±1.52. There were 51 patients （22.08%） whose postoperative cancer staging wasmore advanced than preoperative cancer staging. Postoperative hospital stay was 3-36 （10.79±5.13） days. Primary causesof prolonged postoperative hospitalization included pulmonary air leak，pulmonary infection，preoperative concomitant chronic pulmonary diseases （COPD，asthma），and moderate to severe pulmonary dysfunction. A total of 228 patients werefollowed up for a mean duration of 40.83 months （22-82 months），and 3 patients were lost during follow-up. Overall 5-yearsurvival rates were 85.78%，52.54% and 32.70% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. Five-year cancerfreesurvival rates were 80.00%，45.37% and 20.99% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. ConclusionThe advantages of VATS lobectomy include smaller surgical incision，less injury and postoperative pain，quicker postoperative recovery and shorter hospital stay. Long-term survival rate is comparable to previous international and Chinese studies. VATS lobectomy can anatomically achieve complete tumor resection and systematic lymph node dissection. VATS lobectomy will become a standard surgical procedure for NSCLC patients.