Objective To evaluate the role of preoperative 64 multi-detector spiral CT (MDCT) in predicting the extent of radical resection for advanced gastric cancer (AGC)． MethodsThe imaging data of 70 patients with AGC were collected and analyzed. The N2 lymph node metastasis was predicted by the MDCT indications, and compared with that postoperative pathological results. Results Sixty-two patients were treated with surgical intervention. The sensitivity, specificity, and accuracy of N2 positive prediction by MDCT was 92.0% (46/50), 75.0% (9/12) and 88.7% (55/62), respectively. Extended resection was performed in 81.6% (40/49) patients who were predicted as N2 positive, and D2 resection was performed in 92.3% (12/13) patients who were predicted as N2 negative.Conclusion The MDCT is a valuable technique to predict N2 lymph node metastasis, and to determine the extent of resection for AGC.
Objective To investigate the reasonable indication of splenectomy in radical resection for advanced proximal gastric cancer (APGC). Methods Fifty patients with APGC were studied and classified into total gastrectomy with splenectomy (TGS) group (n=18) and total gastrectomy without splenectomy (TG) group (n=32). The operation time, hospitalized duration, complications, and lymphe node metastasis at the spleen hilus were compared between two groups. Results The operation time, hospitalized duration and subphrenic infection rate in the TGS group were significantly higher than those in the TG group (Plt;0.05). The rate of lymph node metasitasis of No.10 and No.11 in the TG group was not different from that in TGS group (Pgt;0.05). Conclusion Direct spleen and its vessel invasion are the reasonable indication of splenectomy in radical resection for APGC.
Objective To study the effect of HBeAg on recurrence and survival after radical resection of small (≤3 cm) hepatocellular carcinoma (HCC). Methods Two hundreds and twenty-three HCC patients undergone radical resection from 1999 to 2000 were divided into two groups according to serum HBeAg status， HBeAg positive group (n=73) and HBeAg negative group (n=150). The patients’ factors, operative factors and tumorous facors were studied retrospectively between the two groups. And risk factors of overall survival (OS) and disease-free survival (DFS) were analyzed. Results There were no significant differences in operative and tumorous factors between the two groups, but the HBeAg positive group were younger with more severe cirrhosis (P=0.004, P=0.008). The OS and DFS were significantly different between the HBeAg positive group and HBeAg negative group. The 1-, 3- and 5-year OS were 91.5%, 76.8%, 60.1% and 95.2%, 85.3%, 73.2%, respectively (P=0.053)； and the 1-, 3- and 5-year DFS were 73.3%, 53.7%, 40.3% and 86.6%, 65.5%, 54.5%, respectively (P=0.002). Multivariate analysis revealed that age ＞50 years, HBeAg positive and macronodular cirrhosis were significantly related to OS, and HBeAg positive, multiple tumor nodulars were significantly related to DFS. Positive serum HBeAg status was an independent risk factor for both OS and DFS. Conclusion Positive serum HBeAg is closely related to early recurrence and survival after radical resection of patients with small HCC.
Objective To study the application of ultracision harmonic scalpel in laparoscopic radical gastrectomy. Methods Ten patients with gastric cancer were given laparoscopic-assisted radical gastrectomy by using ultracision harmonic scalpel. Results All operations were successfully performed with ultracision harmonic scalpel, and none of which converted into open surgery. The operation time was 300-492 min, mean (385±64) min. The blood loss was 100-500 ml, mean (401±70) ml. The number of harvested lymph nodes was 21-43, mean 31±6. The time for gastrointestinal function recovery was 3-6 d, mean (4.2±1.0) d. The time of patients’ taking out-of-bed activity was 3-７ d, mean (4.5±1.3) d. The time of taking liquid food was 4-６ d, mean (5.0±0.9) d. No case had relapse or metastasis after 4-20 months (mean 12.6 months) of follow-up. Conclusions Laparoscopic radical gastrectomy by using ultracision harmonic scalpel is safe and feasible. Ultracision harmonic scalpel has the advantage of minimal invasion, less bleeding and shorter operation time, which is a very important equipment and useful for laparoscopic gastrointestinal surgery.
Objective To analyze the risk factors inducing tumor cells exfoliating during radical resection of rectal cancer. Methods Sixty patients who were diagnosed as rectal cancer from May 2006 to November 2007 and given radical operations were assigned prospectively in this study. Before cutting the rectal stump below the tumor, saline was instilled into rectum to irrigate the stump. Collected irrigating fluids were sent to pathology laboratory, and the exfoliated malignant cells were tested by HE （haematoxylin and eosin） dyeing and common smear technique. The results of examines were collected and statistical analysis, including a Logistic regression model, was performed. Results Exfoliated malignant cells were found in 27 samples. By univariate analysis, the statistically significant factors defining a high risk of exfoliating were age, tumor size, TNM stage, operation time and operation method (Plt;0.05). Only TNM stage， operation time and operation method were confirmed by Logistic regression analysis to independently result in a statistically significant increased risk of exfoliating. Conclusion Irrigating the rectal stump before cutting down the tumor is essential to avoid local recurrence. The effects of TNM stage, tumor size and operation time are important. Although the laparoscopic surgery is more predominant than conventional surgery for non-neoplasma technology, irrigating is an important process.
Objective To study the feasibility of radical resection of gallbladder cancer with extensive invasion. Methods A patient of the gallbladder cancer with invasion of liver, gastric antrum, duodenum, caput pancreatis and colon transversum, was received radical resection (including pancreatoduodenectomy, hepatectomy and colectomy). Results Seven months later, the value of CEA and Hb were normal and cancer recurrence was not observed. Conclusion The radical resection of gallbladder cancer with extensive invasion, can improve survival quality and extent survival time.
ObjectiveTo compare the postoperative complications following laparoscopic and open radical resection for rectal cancer. MethodsThe clinical data of 681 patients with rectal cancer from January 2011 to December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively, of whom 583 patients underwent laparoscopic surgery (laparoscopic group) and 98 patients underwent open surgery (open group). The complications were compared between the two groups. Results①There were no statistically significant differences in the gender, age, total protein, albumin, and body mass index between the two groups (P > 0.05). As compared with the open group, the proportions of previous abdominal operation, Dixon operation, and TNM stageⅡandⅢwere lower (P < 0.05), while the use of neoadjuvant chemotherapy was more common (P < 0.05), the distance of the tumor lower margin from the anal verge was shorter (P < 0.05) in the laparoscopic group.②No differences were seen in terms of anastomotic leakage, pulmonary infection, urinary retention, intestinal obstruction, wound infection, abdominal sepsis, urinary tract infection, stoma complications, poor incision healing, bleeding, intestinal hemorrhage, and deep vein thrombosis between the two groups (P > 0.05). ConclusionsThe development of postoperative complications in the laparoscopic group is similar to the open group, which are both available approach to the treatment of rectal cancer. But more randomized clinical trials are warranted to confirm which one is better.
ObjectiveTo observe effect and safety of interstitial chemotherapy with 5-fluorouracil sustained release agent in radical operation of colorectal cancer. MethodsOne hundred and sixty patients with colorectal cancer from October 2011 to December 2013 were randomly divided into observation group and control group according to an incomplete random method, 78 cases of them were in the observation group and 82 cases of them were in the control group. All the patients were performed radical resection of colorectal cancer. The abdominal cavity and pelvic cavity were washed after surgery. 5-fluorouracil sustained release agent was implanted in the observation group patients for interstitial chemotherapy, the implant site was at the tumor resection area and the mesenteric artery. Routine chemotherapy was performed in these two groups after operation. The postoperative complications were observed. The postoperative local recurrence rate, liver metastasis rate, and 24-month survival rate were recorded. ResultsThe rates of abdominal complications and toxic effects had no significant differences between these two groups (P > 0.05). The rates of 12-month and 24-month local recurrence and the rate of liver metastasis in the observation group were significant lower than those in the control group[1.3% (1/78) versus 8.5% (7/82), x2=8.934, P=0.023; 5.2% (4/78) versus 23.2% (19/82), x2=14.834, P=0.004; 10.3% (8/78) versus 18.3% (15/82), x2=12.034, P=0.016]. The rate of 24-month survival in the observation group was significant higher than that in the control group[94.9% (74/78) versus 84.1% (69/82), x2=11.465, P=0.010]. ConclusionThe good safety of interstitial chemotherapy with 5-fluorouracil sustained release agent could effectively decrease local recurrence rate and liver metastasis rate of colorectal cancer after radical operation and improve survival time of patients.
ObjectiveTo explore the efficacy of da Vinci robotic surgical system-assisted radical resection of rectal cancer. MethodsThe clinical data of 456 patients who received radical resection of rectal cancer by the da Vinci robotic surgical system at the Southwest Hospital from March 2010 to March 2016 were retrospectively analyzed. Operative time, operative blood loss, number of harvested lymph nodes, hospital stay, and morbidity were evaluated. Resultsda Vinci robotic surgical system-assisted radical resection of rectal cancer were successfully carried out in 445 patients, and other 11 patients were converted to open surgery (2.4%). Of 456 patients, 322 patients underwent anterior resection of rectum procedure (70.6%), 126 patients underwent abdominoperineal excision procedure (27.6%), 8 patients underwent Hartmann procedure (1.8%). The mean operative time was (192±60) min, the mean operative blood loss was (110±93) mL, the mean number of harvested lymph nodes were 19±6, the mean length between distal resection margin and tumor were (3.5±1.8) cm, the mean time for patients taking normal activity was (2.9±1.5) d, the mean time of passage of the first flatus was (2.7±1.7) d, the mean hospital stay was (7.1±1.6) d. Surgical complications occurred in 40 patients (8.8%), and all the patients were recovery before leaving hospital. The mean follow-up time was 29.1-month (3-75 months). There were 70 patients suffered from occurrence or metastasis (16.2%), and 60 patients died (13.9%). Conclusionda Vinci robotic surgical system-assisted radical resection for rectal cancer is a feasible and safe surgical procedure with the minimal trauma, fast recovery, and satisfactory clinical efficacy.
ObjectiveTo explore the effect of preoperative glucocorticoid on systemic inflammatory indexes and pulmonary inflammation after radical esophagectomy.MethodsA total of 44 patients with esophageal cancer treated in the First Affiliated Hospital of Xiamen University from July 2019 to September 2020 were selected and randomly divided into an intervention group and an observation group by random number table. There were 22 patients in the intervention group, including 20 males and 2 females with an average age of 62.86±5.22 years and 22 patients in the observation group, including 19 males and 3 females with an average age of 63.00±6.19 years. Two groups were given thoracoscope-assisted incision via right chest, upper abdomen and left neck. The intervention group was given an intravenous infusion of methylprednisolone 500 mg before induction of anesthesia, and the observation group was given the same dose of normal saline. The second generation cephalosporins were routinely used to prevent infection in the two groups. The levels of interleukin-6 (IL-6) and C-reactive protein (CRP), lymphocyte and neutrophil count before operation and 1 day, 3 days and 5 days after operation were recorded and compared between the two groups. Utrecht Pneumonia Scoring System (UPSS) score 1 day after operation, the healing of the surgical incision and the anastomotic leakage within 2 weeks after the operation were evaluated.ResultsThe level of IL-6 in the intervention group was significantly lower than that in the observation group at 1 hour and 1 day after operation (both P<0.05). CRP showed significant difference between the two groups 2 days after operation (P=0.044). The white blood cell count in the intervention group was significantly less than that in the observation group 1 day and 3 days after operation (both P<0.05). There was no significant difference in lymphocyte or neutrophil count between the two groups 1 day after operation. There was no significant difference in the rate of non-grade A wound healing or the incidence of anastomotic leakage between the two groups within 2 weeks after operation. The pneumonia score of UPSS in the intervention group was lower than that in the observation group 1 day after operation (P=0.027).ConclusionThe use of glucocorticoid before radical esophagectomy can reduce the systemic inflammatory reaction and improve the short-term postoperative pulmonary inflammation. At the same time, no adverse effect on the healing of surgical incision and anastomotic stoma is found, which has certain safety.