Harmonic scalpel versus conventional resection in thyroid surgery: a meta analysis on the safety outcomes / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the safety between harmonic scalpel and conventional resection in total or near total thyroidectomy with meta-analysis.</p><p><b>METHODS</b>The prospective randomized controlled studies were searched for in electronic databases (MEDLINE, EMBASE, Cochrane Library). Meta analysis of acquired data was performed through the use of RevMan 5.2 software.</p><p><b>RESULTS</b>According to the inclusion criterion, 13 articles were enrolled which compared on the safety between harmonic scalpel and conventional resection in thyroid surgery. A total of 1620 patients with thyroid tumor were enrolled, including 802 patients in harmonic scalpel group and 818 patients in conventional resection group. Compared with conventional resection group, the harmonic scalpel group showed shorter time of surgery, the weighted mean difference (WMD) and their 95% confidence interval (95%CI) was -21.06[-25.65, -16.47], Z = 8.99, P < 0.00001; less intra-operative blood loss, WMD and 95%CI was -14.36[-20.67, -8.06], Z = 4.46, P < 0.00001; less post-operative drain output (WMD and 95%CI was -7.47[-11.35, -3.58], Z = 3.77, P = 0.0002); less hospitalization charges (WMD and 95%CI was -117.97[-131.65, -104.29], Z = 16.90, P < 0.00001). The incidence of postoperative transient recurrent laryngeal nerve dysfunction and transient hypocalcemia were similar in both groups.</p><p><b>CONCLUSION</b>Using the harmonic scalpel in thyroid surgery was as safe as that of the conventional technique with the advantage of shorter time of surgery, less intraoperative blood loss and less postoperative drain output.</p>

A retrospective analysis of clinicopathological characteristics and prognostic factors of gastric stump cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinicopathological characteristics and prognostic factors of gastric stump cancer(GSC).</p><p><b>METHODS</b>The clinical data of 138 patients with GSC treated from January 1992 to July 2008 were reviewed and analyzed. The patients included 122 males and 16 females with a mean age of 61.5 years, and the mean interval between the initial operation and second diagnosis was 21.9 years.</p><p><b>RESULTS</b>The endoscopy and pathological examination showed Borrmann III/IV in 127 (92.7%) patients and undifferentiated carcinoma in 115 (83.3%) patients. The resectability and radical resectability rate were 72.4% and 59.4%. The 1-, 3- and 5-year survival rates was 59.2%, 30.1% and 14.2%, respectively. The median overall survival time was 19.4 months. Univariate Log-rank test indicated that Borrmann type, histological type, tumor diameter, TNM stage, depth of invasion, number of metastatic lymph node, distant metastasis and option of treatment were significant prognostic factors for GSC. While TNM stage, depth of invasion, distant metastasis and option of treatment were prognostic factors on multivariable analysis. The median survival time of patients underwent radical resection was significantly longer (36 months) than that of patients received palliative resection (8 months, P < 0.05) and chemotherapy only (5 months, P < 0.05). Among patients with a tumor of T4 stage, the median survival time was statistically prolonged by combined evisceration (18.6 months) when compared with the patients received palliative surgery.</p><p><b>CONCLUSIONS</b>TNM stage, depth of invasion, distant metastasis and option of treatment are independent prognostic factors for GSC. Early diagnosis and radical resection may play an important role in improving the prognosis of GSC.</p>

Prognostic significance of preoperative serum albumin level in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic significance of preoperative serum albumin in patients with gastric cancer undergoing radical resection.</p><p><b>METHODS</b>A total of 146 patients with gastric cancer underwent radical resection from January 2001 to December 2003. Clinicopathological data were analyzed retrospectively. Patients were divided into two groups, including patients with a normal preoperative serum albumin level(>35 g/L, n=115) and patients with hypoalbuminemia (≤35 g/L, n=31).</p><p><b>RESULTS</b>Patients with a low albumin level were associated with a higher postoperative recurrence rate(90.3% vs. 43.5%, P<0.01). The overall 5-year survival rate in patients with a normal serum albumin level was significantly higher than that in patients with a low serum level(57.4% vs. 9.7%, P<0.01). On multivariate analysis, preoperative serum albumin level was an independent factor associated with survival(P<0.01). When stratified by nodal metastasis, normal serum albumin level was still associated with higher survival rate(P<0.05). Prognostic significance was found in patients with lower stomach cancer(P<0.01), but not in patients with cancer in the upper and middle stomach(P>0.05).</p><p><b>CONCLUSION</b>Hypoalbuminemia is associated with worse survival in patients with cancer in the lower stomach and adjuvant therapy should be considered.</p>

Prognosis of patients with recurrence after curative resection of advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features and prognosis of recurrent gastric cancer.</p><p><b>METHODS</b>Clinical data of 163 patients with recurrent gastric cancer from Jan. 2001 to Jan. 2005 were reviewed. Patients were compared between those with and without symptoms.</p><p><b>RESULTS</b>Seventy-two patients(44.2%) were symptomatic, while 91(55.8%) were asymptomatic. There were significant differences in lymph node metastasis between the two groups(P<0.05). The median overall survival was significantly longer in asymptomatic patients (19.8 vs. 15.7 months, P<0.05). Post-recurrence survival was also longer in the asymptomatic group (9.5 vs. 4.8 months, P<0.01). The median recurrence-free interval in asymptomatic patients was 10.0 months, which was significantly longer than that in the symptomatic patients (9.2 months, P<0.05). On univariate survival analysis,post-gastrectomy chemotherapy (P<0.05), symptoms of recurrence(P<0.01), TNM staging(P<0.01), recurrence-free interval (P<0.01), and reoperation(P<0.01) were associated with the prognosis. On multivariable analysis, TNM staging(P<0.01), symptoms of recurrence(P<0.01), recurrence-free interval (P<0.05), and reoperation(P<0.05) were independent risk factors.</p><p><b>CONCLUSIONS</b>Patients with recurrent gastric cancer have poor prognosis. Close monitoring and active follow-up of patients with gastric cancer should be conducted during the first two years after operation. Reoperation may improve survival in patients with recurrent gastric cancer.</p>

Use of uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer.</p><p><b>METHODS</b>Clinical data of 419 patients who underwent distal gastrectomy for gastric cancer with complete follow-up data between March 2005 and March 2008 in the Cancer Institute and Hospital of Tianjin Medical University. Patients were divided into B I (138 cases with Billroth I reconstruction), M-B II (108 cases with modified Billroth II reconstruction), RY (46 cases with Roux-en-Y reconstruction) and Uncut RY (127 cases with uncut Roux-en-Y reconstruction) according to reconstructive methods.</p><p><b>RESULTS</b>Patients in the Uncut RY group had a larger tumor diameter, more T3, and poorer stage of disease compared to those in the B I (P<0.05). In Uncut RY group, the operative time and postoperative hospital stay were(132.6±19.2) minutes and (10.4±1.2) days respectively, shorter than those in RY group (142.5±11.7) minutes and (12.1±3.7) days(both P<0.05), alkaline reflex gastritis rate was 3.2%, lower than that in B I group (24.6%, P<0.05) and M-B II group (25.9%, P<0.05). Marginal ulcer rate in uncut RY group was lower compared to M-B II group (P=0.019), and incidence of Roux-en-Y stasis syndrome was less compared to RY group (P=0.000).</p><p><b>CONCLUSIONS</b>The uncut Roux-en-Y reconstruction is both feasible and safe. It can prevent alkaline reflex gastritis and Roux-en-Y stasis syndrome. It may be the preferred technique for reconstruction after distal gastrectomy.</p>

Clinicopathological features and prognosis of 68 patients with metastatic ovarian tumors from the gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features and prognosis of metastatic ovarian tumors from gastric cancer.</p><p><b>METHODS</b>Clinical data of 68 patients with metastatic ovarian carcinoma were reviewed retrospectively.</p><p><b>RESULTS</b>The median age was 46 years. The majority of these patients was in the premenopausal state (67.6%) and had bilateral ovarian involvement (64.7%). Pathological type was signet-ring cell carcinoma in 52.9% of the cases. Most of them underwent surgical treatment or chemotherapy or both. The median overall survival was 14.1 months, and the median progression-free survival was 6.7 months. The survival rates in 1-, 3- and 5-year were 54.8%, 14.9% and 0, respectively. Univariable analysis revealed that resection of gastric cancer, lymphatic metastasis, pathologic type of metastatic ovarian tumor, extent of metastatic lesion, cytoreductive surgery and chemotherapy for metastatic ovarian carcinoma were associated with the prognosis. Multivariable analysis revealed that cytoreductive surgery and extent of metastatic lesion were independent factors. Patients with metastatic lesion confined to the ovaries had a median overall survival of 16.0 months as compared to 8.6 months for those with more extensive metastases (P<0.01), and had a median progression-free survival of 8.2 months as compared to 4.1 months for those with more extensive metastases (P<0.05). Patients who underwent optimal cytoreduction(residual lesion < or =2 cm) had a median overall survival of 16.0 months as compared to 9.7 months for those who received suboptimal cytoreduction (residual lesion >2 cm) ( P<0.01). Optimal cytoreduction was also associated with a significantly longer median progression-free survival (11.0 months) as compared to suboptimal cytoreduction median progression-free survival (3.1 months) (P<0.01).</p><p><b>CONCLUSIONS</b>Prognosis of patients with metastatic ovarian carcinoma from gastric cancer is quite poor. Extent of metastatic lesion is an independent factor. Optimal cytoreduction is associated with improved survival.</p>

Prognostic analysis on primary duodenal adenocarcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic factors of primary duodenal adenocarcinoma.</p><p><b>METHODS</b>The medical records of 67 patients with primary duodenal adenocarcinoma treated in our hospital from January 1990 to December 2005 were retrospectively analyzed. Prognostic factors were analyzed by univariable and multivariable analysis.</p><p><b>RESULTS</b>Of the 67 patients, 38 underwent curative resection and 29 underwent palliative resection. The overall 5-year survival rate was 22.4%. The survival was significantly higher in patients who underwent curative resection (5-year survival 39.5%) than that in those who underwent palliative resection(5-year survival 0) (P<0.05). Univariable analysis showed that T-stage, nodal metastasis and tumor stage had significant negative effects on the survival of patients who underwent curative resection. However, multivariable analysis revealed that T-stage and nodal metastasis were significantly associated with survival.</p><p><b>CONCLUSIONS</b>Curative resection may improve the survival. T-stage and lymph nodes metastasis are associated with decreased survival.</p>

Analysis of treatment and prognosis in 132 patients with gastric gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics, diagnosis, treatment and prognostic factors of gastric gastrointestinal stromal tumors(GIST) in the stomach.</p><p><b>METHODS</b>The clinicopathological data of 132 patients with gastric GIST between January 1998 and December 2008 were analyzed retrospectively, and the prognostic factors were evaluated.</p><p><b>RESULTS</b>Tumor locations were the cardia or fundus (50, 37.9%), the stomach body (62, 47%),the antrum (13, 9.8%), and two regions were found in 6 cases (4.5%), three regions in 1 cases (0.8%). Tumor size ranged from 1.0 to 27.0 cm with an average of 9.4 cm. All the patients underwent complete tumor resection, including multi-organ resection in 41 cases. Thirty-four cases underwent lymph node dissection. All the lymph nodes were negative. The positive rate was 93.2% (23/132) for CD 117 and 82.6% (109/132) for CD34. The 1-,3- and 5-year survival rates of the 118 cases with follow up were 94.7%, 80.2%, and 56.6%, respectively. Univariate analysis revealed that the differences in Fletcher classification, tumor size, infiltration to surrounding tissue, preoperative metastasis, and adjuvant postoperative therapy with imatinib were related to the survival rates. Multivariate analysis demonstrated that Fletcher classification, preoperative metastasis and adjuvant postoperative therapy with imatinib were independent poor prognostic factors for survival.</p><p><b>CONCLUSIONS</b>Preoperative metastasis is an independent factor predicting poor prognosis of gastric GIST. Fletcher classification can be used to evaluate the biological behaviors and prognosis, while surgery is the main therapy and targeted therapy can improve survival of gastric GIST.</p>