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ObjectiveTo compare the effects of different surgical approaches on SiewertⅡ (esophageal invasion ≤3 cm) adenocarcinoma of esophagogastric junction.MethodsThis retrospective study included 251 cases of Siewert Ⅱ adenocarcinoma of esophagogastric junction undergoing D2 or D2 + total gastrectomy by transabdominal approach ( TA group, 128 cases) or left thoracoabdominal approach ( LTA group, 123 cases).Operation time,blood loss, extent of esophageal resection, number of lymph nodes dissected,morbidity, mortality and the survival rate were a analyzed between the two groups.ResultsThe 3,5-year overall survival rates were 62. 5％, 39.0％ ( TA group) and 54. 9％, 31.9％ ( LTA group),respectively (P ＞ 0. 05). Length of esophageal resection in the LTA group were slightly longer than that in the TA group (5. 6 ± 1.1) cm vs. (5.4 ± 1.1 ) cm (P ＜0. 05), the positive surgical margin between two groups were not statistically different[1.6％ ( LTA group) vs. 3. 1％ ( TA group), ( P ＞ 0. 05 )]. The mean number of removed lymph node were not significantly different between two groups[23.4 ± 8.7 ( TA group) vs. 23.7 ± 8.4 ( LTA group)], ( P ＞ 0. 05 ). The operation time (227 ± 24) min, blood loss (270 ± 78)ml, and perioperative morbidity( 13.3％ ) and mortality( 1.6％ ) in TA group was significantly better than the LTA group[(261 ±32) min, (342 ±59)ml, 26.8％, 6.5％](P＜0.05).ConclusionsFor Siewert Ⅱ adenocarcinoma at esophagogastric junction (esophageal invasion ≤3 cm) ,total gastrectomy with D2 or D2 + lymph node dissection through the transabdominal approach could achieve curative purposes, with a low morbidity and mortality rate.
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Objective To explore the predictive value of microvessel density(MVD)and blood vessel invasion(BVI)in hepatic metastasis from early-stage rectal cancer.Methods MVD and BVI in the tumor tissue from 380 patients with stage I and II rectal cancer was determined by immunohistochemical S-P method with anti-CDIOS antibody and anti-CD34 antibody,respectively.Multinomial logistic regression was performed to analyze the predictive value of MVD and BVI in hepatic metastasis from early-stage rectal cancer.Results CD105 was expressed in newborn blood vessels,not in normal blood veseels.in the rectal cancer tissue.MVD was correlated with histological type and infiltration depth(P＜0.05).Besides histological type and infiltration depth,BVI was also correlated with histological grade.Multivariate analysis revealed that histological type,tumor infiltration depth,BVI,adjuvant therapy,and MDV were independent predictors of hepatic metastasis from rectal cancer.The risk of hepatic metastasis in patients with postive expression of either MVD or BVI or both were significant higher than that in patients with low expression of MVD and those without BVI expression[hazard ratio(95%CI),4.210(2.182-11.214)].Conclusion BVI and MVD are independent predictors of hepatic metastasis from stage I and II rectal cancer.Combined detection of MVD and BVI may help to predict the clinical outcome of patients with early-stage rectal cancer.
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Objective To detect the clinical factors related with liver metastasis in young patients with rectal cancer.Methods Three hundred and fifty young patients with rectal cancer were collected to set up the database.Single and multi-factor Logistic regression was applied to indicate the independent factors relating to liver metastasis.The regression equation to predict probability of liver metastasis from rectal cancer was established.Results Liver metastasis was 120 cases (34.3%).Single-factor analysis revealed that patho-organization type,pathologytype,infiltration extent,blood vessel invasion (BVI),TNM stage,operation character,the preoperative level of carcino-embryonic antigen,histology grading were related with liver metastasis.Multi-factor analysis revealed that only BVI (P=0.001),TNM stage (P=0.001),pathoorganization type (P=0.005),the preoperative level of CEA (P=0.008) and operation character (P=0.032) were independent factors to predict probability of liver metastasis.Conclusions Rectal cancer of young patients who being with BVI,advanced phase,high preoperative level of CEA,radical operation or poor differentiation degree,are apt to develop liver metastasis.They should be given further individualized intensive adjuvant treatment.
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<p><b>BACKGROUND</b>To evaluate and compare the effects and toxicity of the domestic product of nrhTNF combined with chemotherapy in the trial group and chemotherapy alone in the control group in the treatment of patients with non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Ninety patients with NSCLC in multicenter were randomly devided into trial group and control group. Each group had 45 patients. Chemotherapy with CAP regimen was given for the patients in the trial group. Meanwhile, nrhTNF injection of 4×10⁶U/m ² was also given from the 1st to 7th days, the 11th to 17th days on the chemotherapy course. Twenty-one days were as a cycle, 2 cycles were given each patients. Chemotherapy alone with CAP regimen was given in the control group. The chemothepeutic effects and toxicity were observed and compared between the two groups after the therapy.</p><p><b>RESULTS</b>Of the 90 patients, 3 cases in each group were out of the trial because of economy. The other 84 cases (each group had 42 patients) could be used to analyze and evaluate the clinical effects and toxicity. The response rate of chemotherapy was 47.62% (20/42) in the trial group and 19.05% (8/42) in the control group (P=0.002) respectively. The KPS was 85.02±10.74 in the trial group, and 81.35±9.63 in the control group (P=0.038). No significant difference of degree III+IV toxicity was observed between the trial group and control group (P > 0.05). The side effects related to nrhTNF included slight fever, cold like symptoms, pain, and red and swelling in injection site. All of them were mild and didn't need any treatment and disappeared after the therapy.</p><p><b>CONCLUSIONS</b>The results demonstrate that the effects of domestic nrhTNF combined with chemotherapy can remarkably higher than that of chemotherapy alone in the treatment of NSCLC. It is able to increase the sensitivity to chemotherapy and improve the quality of life of the patients. The toxicity is also slight and is worth to expand clinical use, so as to further evaluate its effect and toxicity.</p>
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<p><b>BACKGROUND</b>To evaluate and compare the effects and toxicity of the domestic product of recombinant mutant human tumor necrosis factor (rmhTNF) combined with chemotherapy and chemotherapy alone in the treatment of patients with non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Two hundred patients with NSCLC in multicenter were randomly devided into trial group (150 cases) and control group (50 cases). Chemotherapy with CAP regimen was given to the patients. Meanwhile, rmhTNF injection of 4×10⁶U/m² was also given from the 1st to 7th days, the 11th to 17th days on the chemotherapy cycle in the trial group. The control patients received chemotherapy alone. Twenty-one days were as a cycle, 2 cycles were given to each patient. The chemotherapeutic effects and toxicity were observed and compared between the two groups after the therapy.</p><p><b>RESULTS</b>of the 200 patients, 5 cases in the trial group and 3 cases in the control group were out of the trial because of economy. The other 192 cases (145 cases in the trial group and 47 cases in the control group) could be analyzed and evaluated the clinical effects and toxicity. The response rate of chemotherapy was 46.90% (68/145) in the trial group and 17.02% (8/47) in the control group respectively ( P =0.001). The KPS scores was 86.02±9.74 in the trial group, and 80.14±9.10 in the control group ( P =0.025). No significant difference of degree III+IV toxicity was observed between the two groups ( P > 0.05). The side effects related to rmhTNF included slight fever, cold-like symptoms, pain and red and swelling in the injection site. All of them were mild and didn't need any treatment and disappeared after the therapy. There were no severe abnormality of liver and kidney function and ECG in both groups.</p><p><b>CONCLUSIONS</b>The results demonstrate that the effects of domestic rmhTNF combined with chemotherapy are remarkably higher than that of chemotherapy alone in the treatment of NSCLC. rmhTNF can increase the sensitivity to chemotherapy and improve the quality of life of the patients with slight toxicity. Hence rmhTNF is worth expanding clinical use.</p>
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<p><b>OBJECTIVE</b>To study the result of surgical treatment of benign ulcer of the gastric cardia.</p><p><b>METHODS</b>Clinical symptom, number, position and size of ulcer, preoperative X-ray gastroscopic examine, type and complication of operation were retrospective analyzed in 21 patients with benign ulcer of the gastric cardia.</p><p><b>RESULTS</b>Average age in 21 patients was 60. Ulcer complicated bleeding in 7 cases (33.3%) and perforation in 5 cases (23.8%). Diagnostic rate of preoperative X-ray and gastroscopic examine was 57.1% and 100%, respectively. Of 21 patients 18 (85.7%) were treated by upper partial gastrectomy, and 3 (14.3%) by total gastrectomy. All were not operative death and anastomotic leak.</p><p><b>CONCLUSIONS</b>upper partial gastrectomy can resect focus of ulcer and decrease secretion of stomach acid. It is a simple and ideal pattern of operation for patients with benign ulcer of the gastric cardia.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Cardia , Prognosis , Stomach Ulcer , General SurgeryABSTRACT
Objective To evaluate total gastrectomy and regular lymph node dissection for the treatment of advanced cardiac cancer. Methods Three hundred and eighty-seven patients with advanced cardiac cancer underwent total gastrectomy D2+ procedure. The relationships between depth of invasion, lymph node metastasis,the number of metastastic lymph nodes dissected and postoperative survival rate were analyzed. Results The 3-year and 5-year survival rates were 47.3% and 34.2% , respectively. Metastatic rate of N3 lymph node was 4. 8% and 15. 2% in advanced cardiac patients of PT3 and PT4, respectively. Survival rates significantly decreased along with the increase of lymph node metastasis. The 3-year and 5-year survival of patients who had less than 15 lymph nodes dissected was significantly poorer than those who had more than 15 lymph nodes dissected, respectively. The postoperative complication rate and mortality rate of the two groups were 14. 2% and 2. 52% , respectively. Conclution To improve the quality of life and survival rate, D2 + radical total gastrectomy should be performed for advanced cardiac cancer, and when indicated resection of spleen and/or body and tail of the pancreas should be performed.
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Purpose:This study was designed to investigate the expression of p27 Kip1 and cyclin D1 in gastric carcinoma in relation to biological behavior and prognosis. Methods:p27 Kip1 and cyclin D1 expression at protein level were determined by immunohistochemistry technique in 92 patients with gastric carcinoma. Results:Of the 92 patients, p27 Kip1 expression was low in 28(71.8%) and high in 11(12%),respectively. Cyclin D1 expression was low in 32 (72.7%) and high in 12 (13%) ,respectively.p27 Kip1 expression level was correlated with histological grade, depth of invasion, lymph-node metastasis, TNM stage( P
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PURPOSE To explore an efficacious therapy for liver metastasis of colorectal carcinomas. METHODS Basing on excision of primary lesions. 86 cases of colorectal carcinomas metastasize to liver were treated in four different manners, namely: sole resection of the metastasis lesions, chemoembolization-resection, sole chemoembolization. and chemotherapy. We also analyze the efficacy in curing single metastatic liver cancer, multiple metastatic cancer that is confined to one section or both left and right sections of liver. RESULTS One year survival rates in the groups of sole resection and chemoembolization-resection are better than that of sole chemoembolization P
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The expression of nm23 gene product/NDPK was studied in curatively resected human gastric carcinoma, using anti-NDPK polyclonal antibody. Of 115 patients tested, 59.1%(68/115) showed positive staining in the primary lesions, and 41.9%(36/86) were positive in the metastatic regional lymph nodes. A significantly higher positive staining rate was found in patients without regional nodal metastasis (86.2%, 25/29) than in those with nodal involvement (50.0%, 43/86; P