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Tumor removal is the only curative method of pancreatic cancer.Although much progress has been made in pancreatic surgery,the most important one is the decline of the perioperative mortality.There were many randomized clinical trials including studies of the extension of the standard operation.1ymphadenectomy and resection margin.However,the long-term survival has not increased,and the median survival no longer than 20 months.According to the situation that many patients should not select resection,we think that it is important to control the surgical complications and to encourage the patients to receive surgery.
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Objective To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors.Methods From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy,including 14 patients with breast cancer,19 with pancreatic cancer,3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors.Fifteen patients were with recurrent tumors.The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy.In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively.The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0).Results The median duration of surgery was 190 minutes.Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxemia, all of which were treated conservatively.The median hospitalization time and time to take out stitches was 12 and 13 days, respectively.And the in-hospital mortality was 4% (2/52).Twentyfour patients suffered post-operative adverse events, including 3 postoperative infections.With a median follow-up time of 183 days, 20% of patients sufferred from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache.Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively.None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy.Conclusions Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone.
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Objective To identify the pmgnesfic factors influencing the recurrence and metastasis of adenocarcinoma of the ampulla of Vater after panreaticoduodenectomy. Methods A retrospective study was carried out on the clinical manifestation, pathological behavior and survival data in 101 patients with Vater's ampullary adenecarcinoma receiving pancreaticoduodenectomy from Jan 1980 to Dec 2003. Results According to TNM system, there were 42 cases (41.6%) of stage Ⅰ, 32 cases (31.7%) of stage Ⅱ, 27 cases (26.7%) of stage Ⅲ. During postoperative follow-up period [ median, 46(2-192) months] 25 patients (24.8%) suffered from recurrence or/and metastasis with the median recurrence time of 20 (2-93) months, among which there were 11(10.8%) cases of local recurrence and 20 (19.6%) cases of distant metastasis. The differences were statistically significant between the patients with recurrence or/and metastasis and those without in the following parameters: tumor size larger than 2 cm (64% vs. 39%, X2=4.56, P=0.033), positive lymph node metastasis in the primary specimens (52% vs. 17%, X2=11.98, P=0.001), postoperative complications (51% vs. 20%, X2=7.50, P=0.006). Logistic regression showed only lymph node status (OR=5.14, P=0.0037) was independent factors of tumor recurrence and metastasis. The median non-recurrent time in those without lymph node metastasis was 49 (2-192) months, significantly longer than the median 32(12-152) months in those with metastasis (X2=5.43, P=0.0198, log-rank test). Conclusions Recurrent metastasis is the main problem in patients with ampullary adenocarcinoma after pancreaticoduodenectomy. The lymph node status is an independent prognostic factor.
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<p><b>OBJECTIVE</b>To improve the diagnosis and treatment of carcinoma of head of pancreas.</p><p><b>METHODS</b>A retrospective study was carried out to evaluate 178 patients suffering from carcinoma of head of pancreas.</p><p><b>RESULTS</b>Pain in the epigastrium and obstructive jaundice were observed in 70% and 74.2% of these 178 patients, both of which were of significance (P < 0.001) between stage I, II and stage III, IV disease. Only 18% of patients had pain in the back, 81.3% of whom belonged to the stage IV category. The detection rate of the tumor by B-ultrasound, CT and MRI were 74.2%, 87.3% and 85.5%, respectively. The success rate of pancreatoduodenectomy was 10.1%. The postoperative 1-, 3- and 5-year survival rates were 67.5%, 36% and 5.6%. Internal drainage was performed in 115 patients. The median survival time was 7 months in patients with unresectable tumor who received radiotherapy and/or chemotherapy.</p><p><b>CONCLUSION</b>Pain in the epigastrium and obstructive jaundice are the most common symptoms. Hyperglycemia is the most common complication. Pain in the back implies an advanced lesion. CT is the most important way of diagnosis and the combination of B-ultrasound, CT and MRI may improve the rate of diagnosis up to 96.6%. By now, pancreaticoduodenectomy is still the only effective treatment for the carcinoma of head of pancreas and internal drainage is an important palliative measure.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Hyperglycemia , Neoplasm Staging , Pain , Pancreatic Neoplasms , Diagnosis , Mortality , General Surgery , Retrospective Studies , Survival Rate , Tomography, X-Ray ComputedABSTRACT
Objective To investigate the postoperative complications, survival and the prognostic factors of surgical treatment of distal cholangiocarcinoma . Methods The clinical data of 23 patients with distal cholangiocarcinoma treated by operation in our department in recent 12 years were reviewed retrospectively. Results The persistent period of symptoms befor operation in patients without postoperative complications ( 1.29?0.23 months) was significantly longer than that in patients with complications (0.50?0.18 months) (P
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Objective To make a preliminary analysis of orthokeratology(OK) for treating myopia.Methods OK lenses were chosen to treat myopia with or without astigmatism according to the myopia characterizations, then changes of their visions, refractions, corneal curvature and eccedtricities after being treated for ld, 1、2、3、4 weeks were observed once every 4weeks and were followed up for 18 months.Results Significant changes were observed after being treated. Slight myopia: the diopters decreased-2.75D±0.50D,the horizontal meridians flattened 1.64±0.21, the vertical 0.92±0.27 and the eccedtricities declined 0.47±0.11; Middle myopia: the diopters decreased -5.50D±0.75D,the horizontal meridians flattened 2.16±0.45, the vertical 1.61±0.67, and the eccedtricities declined 0.38±0.07; High myopia:the diopters did -6.75D±0.50D,the horizontal did 3.86±0.56, the vertical 2.97±0.67 and the eccedtricities did 0.32±0.10. The predicabilities of slight and middle myopia were superior to high myopia's.Conclusion Orthokeratology is a non-traumatic therapy and the clinical application should be careful and scientific.
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Objective To investigate the clinical and pathologic characteristics of rectal gastrointestinal stromal tumor (GIST),and to evaluate the management of rectal GIST. Methods The clinical and pathological data of 19 cases of rectal GIST in recent 19 years were studied retrospectively. Results The diagnosis of 19 cases of rectal GIST were identified by surgery and pathology. Most rectal GISTs were spindle cell type. Immunohistochemical analysis displayed positive reactivity for CD117(100%) and CD34(73. 7% ). Graded by aggressive behavior there were 4 cases of high risk, 3 cases of intermediate risk, 5 cases of low risk and 7 cases of very low risk. Conclusions Rectal GISTs have a low prevalence and have no specific symptom in the early stage. Most tumors are low risk in aggressive behavior. It is difficult to get an accurate pathological diagnosis before operation and difficult to decide whether a sphincter preserving procedure is justified however trans-anal local resection is the therapy of choice for low risk submucosal rectal GIST(
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Objective To evaluate the use of stapling anterior resection for rectal cancer. Methods Data of 1036 patients undergoing anterior resection for rectal cancer during 1983 to 2000 were reviewed retrospectively. Clinical results were compared statistically between patients who received stapling anastomosis (group A, n=652) and those did not (group B, n=384). Results The annual average stapler anterior resection increased from 5 cases per year (during 1983-1987) to 147 cases per year (1998-2000). The 0? Ⅰ? Ⅱ stage patients accounted for 53% in group A, and 62% in group B (P=0.004). There was higher percentage of patients in group A (66%) than in group B (39%) in which the distance from the lower edge of the tumor to anal verge was less than 8 cm (P