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<p><b>OBJECTIVE</b>To evaluate the application of multidisciplinary treatment (MDT) in patients with liver metastasis of colorectal cancer(CLM).</p><p><b>METHODS</b>Clinical data of 118 patients with liver metastasis of colorectal cancer, including 32 patients with MDT (MDT group) and 86 patients without MDT (control group), from February 2014 to April 2015 in PLA General Hospital were analyzed retrospectively. Compliance of preoperative examination and adjuvant therapy, and efficacy-associated indexes were compared between the two groups.</p><p><b>RESULTS</b>(1) As compared to control group, statistically significant increase in imaging examination ratio was found in MDT group: chest CT [87.5%(28/32) vs. 40.7%(35/86), P=0.0000], abdominal MRI [84.4%(27/32) vs.61.6%(53/86), P=0.019], pelvic MRI [63.7%(7/11) vs. 24.3%(8/33), P=0.017]. The preoperative assessment of TNM staging was also higher in MDT group [100%(32/32) vs. 20.9%(18/86), P=0.0000], while there was no significant difference in accuracy rate of TNM staging between the two groups [81.3%(26/32) vs. 66.7%(12/18), P=0.2465]. (2) Rates of preoperative chemotherapy and chemotherapy completion were also higher in MDT group than those in control group [90.6%(29/32) vs. 62.8%(54/86), P=0.0033; 82.8% (24/29) vs. 57.4% (31/54), P=0.000], but conversion rate of unresectable CLM showed no significant difference [24.0% (6/25) vs. 14.3% (7/49), P=0.299 ]. (3) Rate of one-stage resection or ablation was higher in MDT group compared to control group [76.9%(10/13) vs. 36.0%(9/25), P=0.038], and resection rate of metastasis nidus was also higher in MDT group [77.0%(20/26) vs. 44.9%(13/29), P=0.015]. No significant differences were observed in rates of R0 resection, positive surgical margin, lymph node clearance, ablation of metastasis nidus, pathological complete response, postoperative chemotherapy or postoperative complications (all P>0.05).</p><p><b>CONCLUSION</b>MDT has the advantages on standardization of preoperative examination and perioperative chemotherapy, and can improve the rate of one-stage resection or ablation, as well as resection of metastasis nidus.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Colorectal Neoplasms , Pathology , Combined Modality Therapy , Hepatectomy , Liver Neoplasms , Therapeutics , Lymph Nodes , Neoplasm Staging , Postoperative Complications , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Objective Using the scientific thinking mode,applied the standardized training in zero-based assistant of laparoscopic gastrointestinal surgery,observe and explore the effect of shorten learning curve.Methods Took 40 students studied in our hospital from February 2013 to December 2014 as object of our study,who were randomly divided into Group Ⅰ and Group Ⅱ.Group Ⅰ was given standardized training,group Ⅱ was given regular training.After total 200 cases of laparoscopic assisted colectomy,5cases each doctor,we analyzed the two teams outcome of surgery cooperation.Results Compared with the control group,doctors from observation group were better in the surgery cooperation and the examination.Conclusions Standardized training is very meaningful for the zero-based assistant of laparoscopic gastrointestinal surgery.
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Objective To study the anatomical basis and clinical causes of splenic infarction with an attempt to improve on the diagnosis and treatment of splenic infarction.Methods This study was conducted on 11 patients with splenic infarction seen in our hospital from December 2003 to September 2012,131 patients with a clinical diagnosis and treatment reported in the literature since 1999,and 25 adult cadavers showing the anatomy of the splenic arteries with an aim to find out the causes of splenic infarction.Results The clinical data showed that splenic infarction occurred more commonly in patients 60 years of age or older (73％ vs 27％,P＜0.05),and in males more than in females (62％ vs 38％,P＜0.05).The diagnosis was first made significantly more often by physicians than by surgeons 88/32 (79％ vs 21％,P＜0.05).The anatomical data showed that the majority of the splenic arteries in the 25 adult cadavers was curved.Conclusions The clinical manifestations of splenic infarction easily led to a misdiagnosis.Improvement in the diagnosis and treatment of splenic infarction would depend on the clinical awareness of this condition,the prothrombotic state detection and the implementation of timely and standardized treatment.
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The first few cases of colonic surgery using Da Vinci surgical system were reported in 2002;since then,Da Vinci surgical system has gradually been used in several centers for rectal cancer and with favorable outcomes.Laparoscopy has opened a new era in modern surgery,however,the inherent limitations of traditional laparoscopic surgery may cause certain difficulties during manipulation,especially in the demanding field of colonic laparoscopic surgery,which prolonged the learning curve.The advantages of Da Vinci surgical system include stable camera platform,three-dimensional imaging,excellent ergonomics,tremor elimination,ambidextrous capability,motion scaling,and instruments with multiple degrees of freedom.Low rectal region was regarded as the"forbidden zone"for laparoscopy,so we applied the Da Vinci surgical system in low anterior resection for rectal cancer.Because of mulyiquadrant operations in low anterior resection of rectal cancer,moving the robotic cart twice during the operation is necessary,which increased the operation time.In order to solve the problem,many surgeons use conventional laparoscopy for vessel ligation and flexure mobilization,and adopt the Da Vinci surgical system only in the lower quadrant of the abdomen.We present a technique that allows for the complete isolation of the mesorectum from the same position of the robotic cart,during the process,the enhanced dexterity and precise dissection offered by the Da Vinci surgical system were fully utilized.
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@#ObjectiveTo investigate the effect of dendritic cells (DC) sensitized by tumor cells lysates on the murine breast cancer.MethodsBone marrow-generated DCs were sensitized by EMT6 tumor cell lysates, and tested whether they produced antigens to T lymphcytes and induced tumor-specific CTL. Antigen-sensitized DCs were also used to treat the mice with breast carcinoma.ResultsDCs sensitized by tumor cell lysates markedly led to the proliferation of lymphcytes in vitro, and induced tumor specific CTL that significantly difference compared with PBS control group (P=0.027). Meanwhile, DCs sensitized by tumor lysates could inhibit the growth of established murine breast cancer that also significantly difference compared with PBS control group (P=0.035).ConclusionDCs sensitized by tumor cell can induce an effective antitumor immune response both in vitro and in vivo.
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Acute superior mesenteric artery embolism(MAE) is uncommon in clinical, but is a severe surgical abdomen. Owing to its unfamiliarity, clinicians often made misdiagnosis. This report summarized the experience in diagnosis and surgical therapy of 25 cases of acute superior mesenteric artery embolism. The results suggested that patients with a history of heart and peripheral arterial obstructive disease encountering severe abdominal pain and hemorrhage of digestive tract, which could not be relieved by narcotics, should be considered as early signs of acute superior mesenteric artery embolism. Twenty-three were operated out of the 25 cases, among tham, 5 cases were subjected to resection of partial small intestine after removal of the embolus, 18 cases received bowel resection. In the 23 cases of MAE, 10 were cured and 13 died, the mortality in perioperative period was 57%. Early diagnosis and prompt treatment are the key to improve the therapeutic effects of AME.