ObjectivesTo summarize the latest advances about definition, classification, and TNM stage of adenocarcinoma of esophagogastric junction (AEG).MethodThe available guidelines, consensuses, international conference proceedings, and clinical studies were reviewed and summarized.ResultsThe AEG trended to be an independent entity of malignant tumor at the special location. The previous misunderstanding of AEG definitions from the WHO needed to be corrected and unified in China. The Siewert classification was still a practical clinical approach to guiding treatment strategy, while the new draft of JGCA classification needed to be evaluated and verified in the clinical practice. By contrast, the 8th edition AJCC/UICC classification was relatively controversial in the guiding treatment strategies, mainly due to the staging system, surgical approach, and extent of lymphadenectomy of Siewert Ⅱ type AEG. Based on the available research results, the TNM staging system of the 8th edition of gastric cancer tended to be more reasonable for the Siewert Ⅱ and Ⅲ types AEG.ConclusionWith increasing incidence of AEG, more experimental and clinical studies on AEG are ongoing, and it is expected to have more optimized classification and exclusive staging system for AEG in future.
ObjectiveTo review the lymph node metastasis pattern and its dissection value among adenocarcinoma of the esophagogastric junction (AEG) patients, in order to assist suitable individualized lymph node dissection strategies for diverse AEG patients. MethodsThe reports about lymph node metastasis and the value of dissection of AEG worldwide in recent years were retrieved and summarized. ResultsThe sites with higher lymph node metastasis rate of AEG included No.1, No.2, No.3, No.7 lymph nodes, etc. and sites with higher lymph node metastasis rate often benefit from dissection. Lymph node metastasis was related to factors such as tumor size and location, and lymph node dissection at individual sites is still controversial. ConclusionThe lymph node dissection range of AEG is highly controversial, especially for Siewert type Ⅱ AEG, which still requires prospective multicenter studies to prove.
Objective To explore the feasibility of arch-preserved jejunum in total gastrectomy with Roux-en-Y esophagojejunostomy for adenocarcinoma of esophagogastric junction （AEG） and upper-middle gastric cancer. Methods Clinical data of 13 patients who underwent total gastrectomy with Roux-en-Y esophagojejunostomy with usage of arch-preserved jejunum to resolve the anastomosis tension problem in our hospital from Dec. 2012 to Apr. 2013 were analyzedretrospectively， and surgical experience was summarized. Results The maximal and actual extended lengths were （7.75±1.75） cm （4-10 cm） and （5.95±1.82） cm （3-9 cm） respectively， with the utilization percentage of （77.91±16.60）% （50.0%-100.0%）. These patients hadn’t suffered postoperative mortality and severe complications， such as anastomosis leakage， stenosis， hemorrhage， and so on. Besides， there were 1 case complicated with postoperative acute urinary retention and another 1 case complicated with infra-hepatic space abscess and peritoneal infection. Conclusion Arch-preserved jejunum is a practical surgical technique to handle with the anastomosis tension of esophagojejunostomy in total gastrectomy for AEG and upper-middle gastric cancer.
Medical education is undergoing the transition from traditional classroom teaching to more diversified " inside-and-outside-class collaborative teaching”, that is, extracurricular teaching has become an important supplement to medical education. The academic societies of medical students are important platforms in medical education. With the increasing of academic societies in medical colleges, the coordination and balance between community construction and student development requires deep thinking and investigation. The society should develop under the ideas of " following the initial intention - realizing transformation - promoting innovation”. The society-based extracurricular teaching should be performed in the manner of capacity-directing " translational teaching”. The society needs to carry out the " personalized and advanced” training to improve the scientific research or innovation capacity of individual medical student. This paper aims to discuss key points on the construction and management of academic society of medical students at the micro-level, to provide references for single society’s development.
ObjectiveTo explore the diagnostic value of “Four-Step Procedure” of laparoscopic exploration in patients with peritoneal metastasis of gastric cancer.MethodsWe retrospectively collected the data of 409 gastric adenocarcinoma patients from July 2016 to August 2020 who underwent “Four-Step Procedure” of laparoscopic exploration in West China Hospital. The descriptive case series study was conducted to analyze the outcome of laparoscopic exploration combined with CY (cytology test), stepwise treatment plans, and the rates of CY1 and P1 (peritoneal metastasis) among cT3–4 patients during different periods. SPSS 22.0 software was used to conduct the univariate and multivariate logistic regression to analyze the high risk factors associated with P1 and (or) CY1.ResultsA total of 409 gastric adenocarcinoma patients who underwent laparoscopic exploration were enrolled in our study. Among them, 65 patients were confirmed to be P1 and (or) CY1. Stratified analysis by cT and cN staging showed that there were 7 (7.4%) and 55 (27.9%) patients with peritoneal metastasis in cT3 staging and cT4 staging, respectively. After laparoscopic exploration, 168 patients received laparoscopic gastrectomy, 35 patients received laparotomy, 143 patients received neo-adjuvant chemotherapy, and 63 patients received conversion therapy. The bar chart showed an ascending tendency in the diagnosis rate of P1 over time among cT3–4 patients. Multivariate logistic regression analysis showed that ascites was an independent risk factor of CY1 and (or) P1 (P<0.001). Additionally, the postoperative complication rate was 2.9% in the patients who merely underwent laparoscopic exploration, including 4 patients with pulmonary infection and 2 patients with urinary retention.Conclusions“Four-Step Procedure” of laparoscopic exploration is reliable and feasible for gastric cancer. “Four-Step Procedure” of laparoscopic exploration has high diagnostic value for peritoneal metastasis of gastric cancer. Our study shows that most of peritoneal metastasis distribute in cT3 and cT4 patients. For these patients, laparoscopic exploration should be recommended to identify if peritoneal metastasis exists and avoid unnecessary laparotomy.
ObjectiveCD44 and CD54 are two specific biomarkers of gastric cancer stem cells and were used as targets in this study. The number of CD45–CD44+CD54+ cell subsets in peripheral blood of gastric cancer patients was detected by flow cytometry. Further, we combined these results with the clinicopathological characteristics of gastric cancer patients to analyze the significance of CD45–CD44+CD54+ cell subsets.MethodsFrom December 2016 to September 2017, 38 patients with gastric cancer in gastrointestinal surgery of West China Hospital of Sichuan University were included as the study object. The content of CD45–CD44+CD54+ cell subsets in their peripheral blood was detected by flow cytometry and its clinical significance was analyzed.ResultsThe median number of CD45–CD44+CD54+ cells were 541.9/mL (71.7–8 057.0/mL) in 38 patients and 555.9/mL (71.7–8 057.0/mL) in the group of patients with R0 resection. Patients without lymph node metastasis were found to have more CD45–CD44+CD54+ cells than patients with lymph node metastasis [941.4/mL (183.5–8 057.0)/mL vs 379.3/mL (71.7–2 269.7/mL, P=0.002], and more CD45–CD44+CD54+ cells in patients with TNM stage Ⅰ–Ⅱ than in TNM stage Ⅲ–Ⅳ [858.6/mL (183.5–8 057.0/mL) vs 364.6/mL (71.7–2 269.7/mL, P=0.015]. The patients with T3–4 stages (P= 0.025), N+ stage (P=0.009) and TNM Ⅲ–Ⅳ stage (P=0.012) had low ratios of the subgroup with high number of CD45–CD44+CD54+ cells, respectively. We made a more accurate judgment of N stage and TNM stage when we combined tumor size and the number of CD45–CD44+CD54+ cells together. However, there was no significant correlation between the number of CD45–CD44+CD54+ cells and other clinicopathological features and prognosis.ConclusionsThe number of CD45–CD44+CD54+ cell subsets is correlated with tumor progression, which might be used to predict TNM stage and N stage. However, the number of patients included in this study is too small, and the clinical significance of CD45–CD44+CD54+ subsets in gastric cancer patients needs to be further demonstrated by expanding the sample size.