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Objective:To analyze the operative outcomes and postoperative pathological features of retroperitoneal leiomyosarcoma(RPLMS) undergoing surgeries.Methods:Medical records of RPLMS patients admitted to Peking University International Hospital from Jan 2015 through Dec 2020 were retrospectively reviewed.Results:Ninety-seven patients undergoing resectional surgeries were included in the study. Of whom, 49 cases were primary RPLMS. Others were recurrent sarcomas or sarcomas with incomplete resection in the first surgical intentions. The most frequent symptoms were abdominal pain and distention (30 cases) as well as lower back pain (23 cases). All patients underwent resectional surgeries with a R 0/R 1 rate of 84.5%. Sixty-four cases received extended surgeries with combined organs resection. External iliac artery resection with reconstruction were performed on 2 cases. And 19 patients underwent partial IVC resection in combination of sarcoma resection. The general postoperative morbidity was 26.8%, including 4 intestinal fistulas, 1 pancreatic fistula, 1 vesicovaginal fistula, 1 urinary fistula, 1 biliary fistula, 2 abdominal major bleeding, 7 IVC thrombosis, 3 gastroplegiaetc. One patient deceased within post-operative 30 d due to massive bleeding.Pathology found that spindle and pleomorphic cell types were most common subtypes of RPLMS. Conclusions:Surgery remains the mainstay in the treatment of RPLMS which often presents with atypical symptoms. Extended surgeries combining with multiple organ and major vascular resections could be only suggested in experienced sarcoma centers due to high risk of severe postoperative complications.
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Objective:To summarize the experience of surgical treatment of pelvic retroperitoneal neoplasms.Methods:A total of 107 patients with pelvic retroperitoneal neoplasms underwent surgical treatment from Apr 2015 to Sep 2020. According to the neoplasm location, size, and the relationship with the surrounding tissues, individualize the surgical plan, analyze the patient's basic condition, bleeding volume, tumor size, whether it is the first operation,or combined organ resection, etc.to find out the relevant factors affecting the surgical complications.Results:The surgical route included anterior approach in 67 cases , sacrococcygeal approach in 21 cases, combined abdominal-sacral approach in 13 cases, and laparoscopy in 5 cases. Twenty-nine patients underwent combined organ resection, postoperative complications occurred in 27 patients including colorectal anastomotic leakage in 6 cases, urinary fistula in 6 cases, delayed pelvic floor healing in 6 cases, rectovaginal fistula in 3 cases, and postoperative bleeding in 2 cases. The statistical analysis show whether or not first operation is related to the occurrence of complications ( χ2=4.79, P<0.05) Conclusion:Pelvic retroperitoneal neoplasms need to be fully prepared before surgery and individualized design. Intraoperative combined bleeding control measures and combined organ resection can effectively increase the resection rate and ensure the safety of surgery.
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Objective:To evaluate primary retroperitoneal liposarcoma surgeries in combination with involved bowel resection .Methods:Clinical data of primary retroperitoneal liposarcoma patients admitted for surgery at Peking University International Hospital from Jan 2015 to July 2019 were retrospectively reviewed.Results:Twenty-four patients undergoing resectional surgeries combining with bowel resection were included for the study, of which 6 cases underwent right hemicolectomy, 8 did left hemicolectomy, 6 did sigmoidectomy, 2 did proctectomy and 8 did small bowel resection. The post operative morbidity was 38%. 2 of 24 had anastomotic fistula. There was no mortality. Final pathology disclosed well differentiated liposarcoma in 13 and dedifferentiated liposarcoma in 11 cases. 18 cases were confirmed with bowel infiltration pathologically. All patients were followed up after the surgery. After a median of 25 months following up, 8 cases developed recurrences and 3 deceased. Two-year overall survival and progression free survival probability were 91% and 71% respectively. Dedifferentiated liposarcoma as a pathological type was found as the only risk factor associated to poor progression free survival ( Z=2.02, P=0.042). Conclusion:Combining resection of primary retroperitoneal liposarcoma with involved bowel was relatively safe, with low morbidity, increasing tumor clearance. Dedifferentiated liposarcoma is associated wth poor prognosis.
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Objective:To investigate the pathogeny, diagnosis and treatment of solitary fibrous tumors of the abdomen and pelvis.Methods:Retrospective analysis was made on the clinical data of 12 SFT patients undergoing surgical resection in Peking University International Hospital from Jul 2015 to Jul 2019.Results:All patients underwent radical resection. After operation, complications in clued pelvic hemorrhage in 1 case and ureteral fistula in 1 case, all improved after conservative treatment.According to pathological and immunohistochemical results, 7 cases were MSFT and 5 cases were SFT. All patients were followed up for 2-53 months. 5 cases were recurrent, among which 1 case died of intestinal obstruction caused by tumor compression.Conclusion:The clinical manifestations of solitary fibrous tumors are mostly nonspecific.Imaging examination and puncture pathology are of great significance for preoperative diagnosis. Radical resection is an important means to improve the prognosis of patients.
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Objective:To evaluate the clinicopathological features of primary retroperitoneal paragangliomas.Methods:Data of 24 patients with retroperitoneal paragangliomas who underwent surgical treatment in our hospital from Jan 2015 to Dec 2018 was collected and analyzed.Results:Hypertension, abdominal pain/discomfort and headache were the most common complaints while 10 patients were asymptomatic and were diagnosed accidently in routine body examination. Tumor size ranged from 3.4-13.0 cm (6.9±2.5) cm, and all the tumors were located in the vicinity of abdominal aorta and inferior vena cava. All the patients received surgical treatment. Intraoperative blood pressure fluctuations were significantly correlated with prolonged operation time, more blood loss, more blood transfusion and prolonged length of stay (all P<0.05). The median follow-up time was 29 months and 1 patient died from tumor recurrence and progression. The other patients have had a tumor free survival. Conclusions:Surgical resection was the principal treatment of primary paraganglioma. Preoperative assessment was very important for perioperative safety.
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Objective To investigate the expression of Aspartate Beta-Hydroxylase (ASPH) in retroperitoneal liposarcoma (RL)and evaluate its clinical significances.Methods Relevant clinical data of 69 RL cases after surgical resection were collected.The expression of ASPH in tumor tissues was detected by immunohistochemistry.The CTL epitopes of ASPH protein HLA-A2 were predicted by SYFPEITHI and NetMHCpan software.Results The overall positive rate of ASPH expression for the whole group was 81％,that for well-differentiated liposarcoma was 73％,dedifferentiated liposarcoma was 87％ (P ＜ 0.05).ASPH expression was positively correlated with the postoperative recurrence free survival rate (P ＜ 0.05).Five HLA-A2 restricted CTL epitopes (9 peptides) were screened with the method of motif prediction.Conclusions ASPH expression is positively correlated with the degree of malignancy of RL,and the ASPH expression is an independent risk factor for postoperative recurrence free survival rate of RL.Moreover,ASPH was found to have 5 HLA-A2 restricted CTL epitopes,which are expected to be used for the immunotherapy of RL.
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Objective To evaluate surgical treatment for different types of tumor of the suprarenal infrahepatic segment of the inferior vena cava (IVC).Methods A retrospective analysis was made on 8cases of IVC leiomyosarcoma at the suprarenal infrahepatic IVC segment.According to the extent of tumor invasion and collateral circulations,operations included tumor resection plus inferior vena cava reconstruction or tumor resection plus right nephrectomy.Results Tumors were completly resected in all patients.Renal function recovered after operation.During a follow up of 24 mons,7 cases had no recurrence.One case with recurrence after 12 months underwent successful resection and is doing well after a follow-up of 12 months.Conclusion CT and inferior vena cavography can determine the extent of tumor invasion and collateral circulations helping select appropriate surgical aproach before the operation resulting in less renal injury.
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Objective To provide evidence for the application of nutritional intervention strategy by analyzing perioperative nutritional status of retroperitoneal liposarcoma patients.Methods 60retroperitoneal liposarcoma patients were divided into primary group (27 cases) and relapse group (33cases).These patients were put on nutritional risk evaluation using nutritional risk screening (2002)(NRS2002) within 24 hours of admission,and the serum albumin (ALB) value was recorded.Results Preoperative NRS2002 score showed that relapse group had a higher chance of cacotrophy.Serum albumin level from different time point showed that patients in relapse group were more prone to cacotrophy (respectively t =9.174,4.720,10.950,8.772,10.960,all P ＜ 0.05) and subject to slower recovery of gastrointestinal function [(86 ± 15) h vs.(61 ± 6) h] (t =7.903,P ＜ 0.05),prolonged antibiotic use [(15.5 ± 5.6) d vs.(7.3 ± 0.7) d],t =7.55,P ＜ 0.05),the average length of hospital stay was longer [(25.5±6.0) d vs.(14.1 ± 1.7)d] (t =9.571,P＜0.05),and higher inhospita cost [(13.2±5.6) × 104 yuan vs.(6.8 ± 0.9) × 104 yuan] (t =5.871,P ＜ 0.05).Though there was no difference between the two groups in incision complication rates (x2 =2.625,P ＞ 0.05)Conclusions Retroperitoneal liposarcoma patients has perioperative nutritional risk.Compared with the primary group,patients from relapse group have higher chance to got cacotrophy.NRS2002 scoring system is simple,it could be used in predicting nutritional risk for those patients.
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Objective To investigate the clinical curative effect of Milligan‐Morgan and Ligasure blood vessels closed system for conducting mixed hemorrhoidectomy under local anesthesia .Methods 68 inpatients with mixed hemorrhoid in the general sur‐gery department of our hospital from April 2009 to April 2012 were selected and randomly divided into the Ligasure group (observa‐tion group ,34 cases) and the Milligan‐Morgan group (control group ,34 cases) .The operation adopted the local infiltration anesthe‐sia .The postoperative followed up lasted for 6‐36 months .The operation time ,intraoperative blood loss ,total hospitalization cost , postoperative hospital stay time ,postoperative pain degree and the postoperative complications were compared between the two groups .Results The average operation time in the control group and the observation group was (32 .35 ± 10 .24)min and (20 .29 ± 7 .88) min(P=0 .000) ,the average intraoperative blood loss was (29 .71 ± 14 .67)mL and (4 .97 ± 2 .89) mL(P=0 .000) ,the aver‐age postoperative pain score was (5 .88 ± 1 .12) points and (3 .47 ± 0 .83) points(P=0 .000) ,the average postoperative hospital stay time was (7 .97 ± 2 .55) d and (2 .29 ± 1 .17) d(P=0 .000) ,and the average hospitalization expense was (1 541 .32 ± 205 .91) Yuan and (2 872 .32 ± 652 .30) Yuan ,respectively ,the differences between the two groups were statistically significant (P=0 .000) .Dur‐ing the hospitalization period and follow‐up ,the anal exudation rate and the average postoperative pain score in the control group were higher than those in the observation group(P=0 .000) ,the occurrence rate of other complications had no statistically signifi‐cant differences between the two groups .Conclusion The Ligasure operation mode has less intraoperative blood loss ,shorter opera‐tion time and shorter postoperative hospital stay time .
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BACKGROUND: Crohn's disease is complex and lack of specificity; meanwhile, it is related to diseased regions, areas,severity and complications in intestine. Otherwise, it is difficult to diagnose. The etiological factors are still unclear and radical therapy is lack recently. Therefore, clinical manifestations and therapeutic measures of Crohn' disease at home are different from those abroad.OBJECTIVE: To compare the clinical characteristics and therapeutic differences between the Chinese and American patients with Crohn's disease.DESIGN: Retrospective case analysis.SETTING: Department of Digestion, General Hospital of Chinese PLA.PARTICIPANTS: A total of 85 Chinese patients with Crohn's disease were selected from General Hospital (the 301 Hospital) of Chinese PLA from 1985 to 2004; meanwhile, a total of 68 American patients with Corhn's disease were selected from Cleveland Clinic Florida (CCF) from 1985 to 2004. Diagnostic criteria were based on WHO standards and all patients were diagnosed according to endoscope, X-ray manifestations and pathological characteristics.METHODS: Clinical data, including age, sex, family history, external manifestations of intestine, diseased regions and characteristics, drug treatment and surgical therapy, were compared between Chinese and American patients.Otherwise, enumeration data were compared with Chi-square test.MAIN OUTCOME MEASURES: Age, sex, family history, extra intestinal manifestations, diseased regions and characteristics, drug treatment and surgical therapy of Crohn's disease.RESULTS: ① General status and extra intestinal manifestations of intestine: The ratio of male and female patients in the 301 hospital was 1.74:1 and in CCF was 1:1.43. The incidences of positive family history and extra intestinal manifestations were 7% and 34%, which were higher in CCF than those in the 301 hospital (1%, 14%, x2=4.631 2, 8.315 0,P ＜ 0.05). ② Diseased regions and pathological characteristics: The terminal ileum was involved at most (69%) and no patients had perianal diseases in the 301 hospital and the main pathological characteristics were ulcer (66%) and obstruction (14%). Those were higher than those of patients in CCF (25%, 4%, x2=25.309 2, 4.024 6, P＜ 0.05).Compared with the 301 hospital, the patients in CCF had more pathological changes in colon and rectum and more perianal diseases and intra-abdominal fistulas were involved (51%). The incidences of perianal diseases and intra-abdominal fistulas were 51% and 9%, which were higher than those of patients in the 301 hospital (0, 6%, x2=38.429 0, 0.148 2, P ＜ 0.05). ③ Therapy: The main selections of medicine were sulfasalazine salicylazosulfapyridine (SASP, 54%), 5-aminosalicvlic acid (5-ASA, 19%) and metronidazole (21%) in 301 hospital, but in CCF, steroids (60%),azathioprine (34%) and infliximab (46%) were the main selections of medicine. Rates of surgical therapy were higher in CCF than those in the 301 hospital (96%, 49%, x2=36.145 9, P ＜ 0.01).CONCLUSION: There are significant differences in clinical characteristics and therapeutic measures between Chinese and American patients with Crohn's disease, which is one of the reasons for the two hospitals to take different treatments.
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<p><b>OBJECTIVE</b>To investigate the reasons for the rarity of metastases in skeletal muscle.</p><p><b>METHODS</b>By injecting tumor cells (Walker256 rat carcinosarcoma) through the iliac artery (experimental group) and the tail vein (control group), animal models of blood-borne metastases were established. The quadriceps femoris muscle and lungs were observed grossly and microscopically. Immunohistochemistry was applied to investigate the expression of vascular cell adhesion molecule-1 (VCAM-1) in the microvascular endothelium of these organs. Primary culture of rat skeletal muscle cells was established and conditioned medium (MCM) was collected. Effects of MCM on several tumor cell lines and the biochemical characteristics of skeletal muscle delivered tumor factor(s) were tested by MTT assay. Apoptosis and morphological examination were carried out to investigate the antitumor mechanisms of MCM.</p><p><b>RESULTS</b>In the experimental group, there were no definite metastases observed in muscle cells. In the control group, lung metastases were present in the lungs of all rats that were sacrificed at the 14th day or died spontaneously (17 rats in all). There was no significant difference between the increase in VCAM-1 in quadriceps femoris muscle 7 days after iliac artery injection and that in lungs 7 days after tail vein injection (P > 0.05). In vitro studies showed that the proliferation of tumor cell lines of mouse SP2/0 myeloma, rat Walker256 carcinosarcoma or human chronic granulocytic leukemia K562, human acute lymphatic leukemia HL-60, LS-174-T colon adenocarcinoma, PC3-M prostatic carcinoma and lung giant cell carcinoma with different metastatic potency (PLA801-C with low metastatic potency, PLA801-D with high metastatic potency) was significantly inhibited when cultured with MCM (P < 0.01 - 0.05). Proliferation of malignant cells showed a dose-dependent decrease, to a certain degree. Proliferation of normal rabbit joint epiphysial disk cells (RGP-2) were not affected by MCM. Proliferation of lung giant cell carcinoma cells with high metastatic potency showed a significant decrease even when cultured in highly diluted MCM (6.25% of primary MCM), when compared with the strain of low metastatic potency. Following ultrafiltration, boiling at 100 degrees C, and treatment with trypsin, skeletal muscle delivered tumor factor(s) were found to be a low molecular weight (MW <or= 10.0 KDa) component which was trypsin resistant but not heat resistant. The factor(s) did not induce apoptosis in K562 cells but caused direct destruction of the cytoplasmic membrane.</p><p><b>CONCLUSIONS</b>The rarity of metastases in skeletal muscles, generally accepted in the clinical setting, can be reproduced in an animal model. It does not seem to be related to VCAM-1 expression in the microvessels of these organs. Skeletal muscle delivered factor(s) play a key role in the mechanism of the rarity of metastases in skeletal muscle.</p>
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Animals , Humans , Rats , Cell Division , Immunohistochemistry , Muscle Neoplasms , Pathology , Muscle, Skeletal , Physiology , Rats, Wistar , Tumor Cells, Cultured , Vascular Cell Adhesion Molecule-1ABSTRACT
Objective To compare the clinical characteristics and therapeutic differences between the Chinese and American patients with Crohn′s disease. Methods 85 patients in the Chinese PLA General Hospital (301 Hospital) and 68 patients in the Cleveland Clinic Florida (CCF), USA with Crohn′s disease from 1985 to 2004 were studied retrospectively. The statistic data were analyzed with Chi-square tests. Results The ratio of male and female patients in 301 Hospital was 1.74∶1 and in CCF was 1∶1.43. The incidence of positive family history and extra intestinal manifestations in CCF were higher than in 301 Hospital (P
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Objective To explore the organic micro environmental effect of skeletal muscles on the proliferation of thoracic malignant cells, its significance in the rarity of metastases in skeletal muscles and the prospect for its clinical applications.Methods Primary culture of new born Wistar rat skeletal muscle cells was established.The murine skeletal muscle conditioned medium(MMCM)was prepared to test its effect on thoracic malignant cell lines of A549、Anip-973,PLA-801C,NCI-H466,Eca109 and benign cell line of BHK-21 by MTT assay.Results Proliferations of thoracic malignant cell lines of A549,Anip-973,PLA-801C,NCI-H466,and Eca109 were significantly restrained when cultured with MMCM,while the proliferation of benign renal cell line(BHK-21)was not affected.Conclusions The conditioned medium of new born Wistar rat skeletal muscle cells could selectively inhibit the proliferation of thoracic malignant cells in vitro.Moreover,it affects tumor cells only and has no apparent effect on normal cells,which differs from most of the chemotherapeutic agents.These findings suggest a sound mechanism in the rarity of metastases in skeletal muscles.A therapeutic agent could be generated from MMCM to complement surgery and/or chemotherapy.
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To investigate the relation between AR and the survival period in patients with colorectal cancer.Multiple variance Cox regression analysis was performed between AR, DNA and CEA in tumor tissues and normal mucosa, and other host and tumor characteristics, such as gender, age, location of tumor (colon, rectum), degree of differentiation (high, middle, low), Dukes stage (A,B,C,D) and the survival period, in 30 colorectal patients. There were no significant differences with regard to gender, age, histological differentiation, AR, DNA and CEA levels in tumor tissues. Rectal carcinoma had poorer prognosis than colon carcinoma ( P
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AIM To investigate the effects of pioglitazone on cardiac hypertrophy in vitro. METHODS Hypertrophy in neonatal rat cardiac myocytes (MC) and cardiac nonmyocytes (NMC) was established with angiotensinⅡ (AngⅡ). mRNA expression of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) was measured by reverse transcription polymerase chain reaction (RT PCR). MTT assay and 3H TdR uptake was used to estimate proliferation of NMC. The surface area of MC was analyzed by the aid of NIH Image J software, and the synthetic rate of protein in MC was detected by 3H leucine incorporation. RESULTS In the condition of hypertrophy, increases of surface area,mRNA expression of ANP and BNP and 3H leucine incorporation in MC and an increase of proliferation in NMC were detected, but no changes in mRNA expression of ANP and BNP in NMC. Pioglitazone inhibited the changes above and reduced mRNA expression of ANP and BNP in NMC in a dose dependent manner. CONCLUSION The results demonstrate that pioglitazone inhibits cardiac hypertrophy in vitro and it suggests that pioglitazone has a potential role in the prevention and treatment of cardiac diseases such as cardiac hypertrophy.
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To investigate the mechanisms of the rarity of metastasis to skeletal muscles. Animal models of blood borne metastasis to skeletal muscle and lung were established,VCAM 1 expressions of the microvascular endothelium in these organs were estimated using immunohistochemistry.The effects of skeletal muscle conditioned media(MCM) on several tumor cell lines were tested by MTT assay.Tumor cells or metastatic foci could be seen rarely in the connective tissue beside muscle bundles of the femoral muscles,however, there is no metastatic foci among muscle cells.The difference of metastatic rate between skeletal muscles and lungs was significant( P
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Objective To analyze the clinical characteristics of primary retroperitoneal tumors(PRPT) and to improve the diagnosis and treatment of these tumors.Methods The clinical characteristics, surgical treatment and prognosis in 352 cases of primary retroperitoneal tumors were retrospectively studied, and the factors affecting postoperative recurrence were also investigated. Results The most common clinical manifestations in 352 cases of PRPT included abdominal mass,abdominal pain,abdominal distention, and lumbar pain. The size of the majority of PRPTs was large, and pathological patterns of them were varied. Urinary system, digestive system and large vessels were often involved. The resection rate was 87.99%. Removal of the involving organs or vessels were often necessary to achieve a complete resection of the tumor. The nature of the tumor and completeness of tumor were the major risk factors for postoperative recurrence. Conclusion The clinical manifestations, pathological types, involved organs and surgical treatment are complicated in PRPTs. Complete resection is the only effective method for the treatment of PRPTs, and it is one of the major factors in reducing recurrence.
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To sum up the experiences and results of surgical treatment for recurrent rectal carcinoma after rectectomy, pelvic exenterations were carried out for 49 patients with the disease and the survival rate was estimated. No death occurred in our group. The resect rate was 91 8%, and the operative complication rate was 12 2%. The 3 year survival rate was 85 5%, and the 5 year survival rate was 60 6%. Pelvic exenteration can improve the survival rate for recurrent rectal carcinoma after rectectomy. Urinary reconstruction and repair of pelvic peritoneum are important for reducing operative complications.