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Objective:To assess rapid on-line evaluation (ROLE) of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic masses.Methods:Data of patients with solid pancreatic masses who underwent EUS-FNA in Peking University First Hospital from October 2017 to October 2019 were retrospectively analyzed. Patients were divided into the ROLE group and the control group. The number of FNA passes in ROLE group was decided by the cytopathologist based on the number of pancreatic tissue cells or heteromorphic cells obtained, while that in the control group was decided by the endoscopy physician according to the visual observation of tissue strips. The cytological and histological diagnosis of EUS-FNA specimen were made by another cytopathologist. The gold standard for final diagnosis was based on the histological diagnosis of surgically resected specimens. For patients who did not undergo surgical treatment, the final diagnosis was made based on the clinical course, imaging, tumor markers and feedback on treatment. The diagnostic yield, the accuracy, the sensitivity, the specificity, FNA passes, puncture time and adverse events were compared between the two groups.Results:A total of 87 patients were enrolled, 51 in the ROLE group and 36 in the control group. The diagnostic yield of the ROLE group was higher than that of the control group without significant difference [98.0% (50/51) VS 86.1%(31/36), P=0.078]. The number of FNA passes in the ROLE group was significantly less than that in the control group (median 2 VS 3, P<0.001). No significant difference in mean FNA puncture time was found between the ROLE group and the control group (19.4 min VS 18.5 min, P=0.089). There were no significant differences between the two groups with regard to the diagnostic yield, the sensitivity, the specificity, the positive predictive value, the negative predictive value or the incidence of adverse events. Conclusion:ROLE of EUS-FNA for pancreatic solid tumor may improve tissue acquisition for puncture, reduce the number of FNA passes, and may not significantly increase the procedure time and risk of puncture.
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Objective:To assess the effectiveness and safety of endoscopic submucosal dissection (ESD) in the treatment of early esophagogastric junction (EGJ) cancer and precancerous lesion.Methods:Clinical data of 67 patients with Siewert type Ⅱ early EGJ cancer or precancerous lesion who underwent ESD at Endoscopy Center of Peking University First Hospital from July 2012 to June 2019 were retrospectively analyzed. Clinical and pathological features, technical data and complication rate were reviewed. The factors that may affect the curative resection were analyzed.Results:Among the 67 cases, 5 were protruding type, 59 flat type, and 3 depressed type. The median lesion diameter was 1.6 ( QR: 1.8) cm, the median operation time was 60.0 ( QR: 56.0) min. The en bloc resection rate was 97.0% (65/67), the complete resection rate was 91.0% (61/67), and the curative resection rate was 82.1% (55/67). Factors related to non-curative resection were tumor size ( OR=8.457, 95% CI: 1.227-58.302, P=0.030) and pathological type ( OR=15.133, 95% CI: 1.518-150.870, P=0.021). ESD-related complications occurred in 3 cases (4.5%), including 1 case of delayed hemorrhage who received endoscopic hemostasis therapy, and 2 cases of post-operative cicatricial stricture who then received endoscopic dilation. Fifty-eight patients were followed up, and recurrence was found in 1 patient during follow-up with positive vertical margin who refused subsequent therapy.Metachronous early gastric cancer was found in another patient during follow-up, who was treated with a second ESD. Conclusion:ESD is a safe, effective and less invasive technique for early EGJ cancer and precancerous lesion. Tumor size, boundary and infiltration depth of the lesion should be accurately evaluated before operation to formulate appropriate treatment strategies.
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Objective:To evaluate the safety and efficacy of rubber band and clip facilitated endoscopic submucosal dissection (RAC-ESD) for colorectal neoplasms.Methods:A retrospective cohort study was performed. Clinical data of 115 patients with colorectal neoplasm receiving ESD from September 2018 to August 2019 were retrospectively analyzed. Thirty-four patients received RAC-ESD treatment (RAC-ESD group) and 81 received conventional ESD treatment (conventional ESD group). The procedure time, the dissected area per minute during ESD, en bloc resection rate, complete resection rate, curative resection rate, complication occurence and recurrence rate were compared between the two groups.Results:The median specimen area of RAC-ESD group was 6.32 (7.53) cm 2, and the median procedure time was 40.0 (55.0) min. The mean dissected area per minute was 0.14 (0.20) cm 2/min. While in conventional ESD group, the median specimen area was 4.71 (5.02) cm 2, the median procedure time was 50.0 (50.0) min and the mean dissected area per minute was 0.09 (0.07) cm 2/min. The median specimen area of RAC-ESD group was slightly larger and the median procedure time was slightly shorter than those of conventional ESD group, but neither was significantly different(both P>0.05). The median dissected area per minute of RAC-ESD group was significantly larger than that of the conventional ESD group ( P=0.008). The en bloc resection rate, complete resection rate and curative resection rate of RAC-ESD group were 100.0% (34/34), 100.0% (34/34) and 97.1% (33/34), while those of the conventional ESD group were 100.0%(81/81), 96.3%(78/81) and 91.4%(74/81), respectively. There was no ESD-related complication in either group. After 10.0±5.5 months of follow-up, there was no local recurrence in both groups. Conclusion:RAC-ESD may increase resection efficacy with safety.
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Objective@#To evaluate the short-term and long-term efficacy of endoscopic submucosal dissection (ESD) in the treatment of early low rectal cancer and precancerous lesions.@*Methods@#Inclusion criteria: (1) Distance from the lower margin of tumor to the anal was ≤ 5 cm. (2) Early low rectal cancers were any size rectal epithelial tumors with infiltration depth limited to the mucosa and submucosa, which were diagnosed by postoperative pathology as high-grade intraepithelial neoplasia or adenocarcinoma of the rectum with infiltration depth of intramucosal or submucosal cancer (M or SM stage). (3) Precancerous lesions included adenoma and low-grade intraepithelial neoplasia of the rectum. (4) Patients received ESD treatment. Patients with tumor invasion depth over submucosa by pathology were excluded. From January 2008 to January 2018, 63 patients meeting the above criteria in Peking University First Hospital were enrolled in this descriptive cohort study. The disease characteristics, clinical manifestations, pathological types, treatment time, hospitalization time, en bloc resection rate (resection of the whole lesion), complete resection rate (both the horizontal and vertical incision margins were negative), postoperative complications and follow-up results were analyzed. Cummulative survival rate was calculated by Kaplan-Meier.@*Results@#The diameter of the lesion was (29.0±23.4) mm and the distance from the lesion to the anus was (2.7±1.8) cm. The median operation time was 45.0 (range, 10.0 to 360.0) minutes, the median hospitalization time was 3.0 (range, 2.0 to 12.0) days, en bloc resection rate was 100%, complete resection rate was 96.8% (61/63), and 1 case (1.6%) had postoperative bleeding. The follow-up rate was 87.3% (55/63) and the median follow-up time was 57.9 (range, 15.6 to 121.1) months. No local recurrence was found during the follow-up period and the 5-year survival rate was 100%.@*Conclusion@#Short- and long-term efficacy of ESD are quite good in the treatment of patients with early low rectal cancer and precancerous lesions.
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Objective To investigate the correlation between clinicopathological features and lymph node metastasis in early gastric cancer (EGC) and evaluate the influence of lymph node metastasis on the overall survival.Methods The clinicopathological data of 178 EGC patients undergoing radical gastrectomy with lymphadenectomy in Peking University First Hospital between Jan 2006 and Dec 2015 were retrospectively reviewed.The impact of lymph node metastasis on the overall survival was analyzed.Results Lymph node metastasis was detected in 19 (10.7％) of 178 patients.Univariate analysis showed a positive relationship between tumor size (x2 =4.804,P =0.028),depth of invasion (x2 =8.176,P =0.003),histological type (x2 =4.333,P =0.037),vascular tumor thrombus (x2 =9.992,P =0.002) and lymph node metastasis in EGC.Multivariate analysis revealed that depth of invasion (Wald =4.954,P =0.026)and intra-vascular tumor thrombus (Wald =3.966,P =0.046) were independent relative factors of lymph node metastasis in EGC patients.The 5-year survival rates of EGC patients with lymph node metastasis were 78.9％,much lower than that without lymph node metastasis (94.3％,x2 =8.310,P=0.004).Conclusions Lymph node metastasis in EGC is mainly correlated with depth of invasion and intra-vascular tumor thrombus.The prognosis of patients with lymph node metastasis is significantly poorer than those without lymph node metastasis.
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Objective To investigate the efficiency and safety of endoscopic submucosal dissection (ESD)for rectal neuroendocrine neoplasm(NEN). Methods A retrospective analysis was performed on data collected from 58 consecutive patients with rectal NEN,who underwent endoscopic ultrasonography and followed by ESD from January 2006 to January 2016 at Peking University First Hospital. Patients′endoscopic and pathological features, clinical manifestations, R0 resection rate and follow-up results were studied. Results En bloc resection was achieved for all of the 58 lesions with a mean diameter of 7.6 mm(range 3.0-18.0 mm). The complete resection rate was 94.8%(55/58). One patient showed postoperative bleeding. The diameter of lesion more than 15 mm increased the risk of non-R0 resection(P<0.05). During the mean follow-up of 3.2 years(range 1.2-11.2 years), all patients remained free from local recurrence. However,distant metastasis was detected in 1 NEN G2 patient with lymphatic invasion(1.7%). Conclusion ESD is effective for treatment of rectal NEN with diameter less than 15 mm and causes less complications. Tumor features and stage determine the risk of distant metastasis,so long-term follow-up is essential.
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<p><b>OBJECTIVE</b>To compare the clinical efficacy of endoscopic submucosal dissection (ESD) and surgical resection for early gastric cancer (EGC). Method The retrospective case-control study was conducted. Clinical and pathological data of 246 patients who were diagnosed as early gastric cancer and received ESD or surgery for EGC at Peking University First Hospital from 2010 to 2015 were collected, including 171 males and 75 females with average age of (63.6±10.8) years. Eighty-one patients received ESD according to the following indications: no peritoneal lymph node metastasis in preoperative CT; differentiated mucosal cancer without ulcer findings, irrespective of tumor size; differentiated mucosal cancer with diameter ≤30 mm and ulcer; differentiated minimal submucosal invasive cancer (≤500 μm from the muscularis mucosa) with diameter ≤30 mm and without ulcer; undifferentiated mucosal cancer with diameter ≤20 mm and without ulcer; high grade intraepithelial neoplasia with diameter >20 mm; mucous lesion recurrence after EMR without chance of EMR again. One-hundred and sixty-five cases received surgery according to the findings of peritoneal lymph node metastasis in preoperative CT or the growth of carcinoma beyond the expanding criteria of ESD (surgery group). En block resection rate (removing all the lesion at once) and curative resection rate [standard: negative horizontal and vertical surgical margins; negative vessel carcinoma embolus; pT1a and pT1b (SM1); lesion diameter <3 cm with differentiated type, pT1a with ulcer or pT1b(SM1); lesion diameter <2 cm with undifferentiated type, pT1a without ulcer] were compared between two groups. According to pathological results, including tumor location, macrographic type, size, pathological type, differentiated type, invasive depth, surgical margin, vessel carcinoma embolus and lymph node metastasis, all the patients meeting the ESD curative resection criteria in both groups were subgrouped in order to compare the baseline information, surgical conditions, postoperative complications, recovery, follow-up and survival. The end of follow up was December 2016.</p><p><b>RESULTS</b>The en block resection rate was 93.8%(76/81), while curative resection rate was 91.4% (74/81) in ESD group. The en block resection rate and curative resection rate was both 100% in surgery group. According to the pathological results, 170 cases were confirmed to be in accordance with the curative resection standard, including 74 cases in ESD group and 96 cases in surgery group. Subgroup analysis showed that ESD group had older cases (t=2.939, P=0.004) and more cases with lesion in upper 1/3 of stomach (χ=8.992, P=0.011), while no significant differences in tumor size, invasion depth, degree of differentiation (t=1.875, 2.393, 3.074, all P>0.05) were observed. Compared to surgery group, ESD group had significantly shorter operative time [(76.4±46.3) minutes vs. (271.9±92.6) minutes, t=17.950, P=0.000], shorter fasting period [(3.2±1.4) days vs. (8.8±5.4) days, t=9.801, P=0.000], shorter hospital stay [(9.0±5.8) days vs. (22.1±9.1) days, t=11.471, P=0.000], less costs [(2.6±2.2) ten thousand yuan vs (7.4±3.0) ten thousand yuan, t=12.235, P=0.000] and lower morbidity of early-stage postoperative complication [1.4%(1/74) vs. 20.8%(20/96), χ=14.502, P=0.013]. One-hundred and sixty-two of 170 patients (95.3%) were followed up for median time of 28 months (range, 11 to 84 months). The recurrence rate was 2.7% (2/74) in ESD group and 4.2% (4/96) in surgery group respectively without significant difference(χ=1.787, P=0.409). Five-year overall survival rate was 97.5% and 96.5% respectively without significant difference as well (χ=0.115, P=0.735).</p><p><b>CONCLUSIONS</b>ESD is an effective and safe treatment of early gastric cancer. It can be used as the first protocol for well-differentiated mucosal or SM1 EGC without ulcer as well as undifferentiated mucosal EGC with diameter less than 2 cm.</p>
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Objective To assess the efficiency and safety of endoscopic submucosal dissection (ESD)on treatment of colorectal lesions. Methods Clinical data of 163 patients with colorectal lesions, who underwent ESD at Endoscopy Center of Peking University First Hospital from June 2012 to June 2016, were retrospectively analyzed. The clinicopathologic features, the rate of en bloc resection, complete resection,complication and recurrence were reviewed. Results Among the 163 colorectal lesions,118 were mucosal lesions and 45 were submucosal ones. The mucosal lesions included 31 cases of protruding type,22 of flat type and 65 of laterally spreading tumor(LST). The submucosal lesions were all protruding type. The median lesion diameter was 2.2(2.0)cm, median operation time was 42(53)min. En bloc resection rate was 92.6%(151/163),and complete resection rate was 86.5%(141/163). The risk factor related to en bloc resection rate and complete resection rate was tumor size(P<0.05).Complications occurred in 4 cases, including 2 cases of intraoperative bleeding and 1 case of delayed bleeding who received endoscopic hemostasis therapy,and 1 patient with delayed perforation,which was managed by emergency surgery. Four recurrences were observed in 135 cases during follow-up, of which 3 were cured by additional endoscopic treatment,and 1 by surgery. Conclusion ESD is a safe and effective, but less invasive technique for colorectal lesions. Favorable long-term clinical outcomes can be achieved when en bloc curative resection is performed.
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Objective To evaluate safety and efficacy of endoscopy therapy for early colorectal carcinoma of different types. Methods Clinical data of 113 patients with early colorectal carcinoma who were treated with different endoscopic therapies including polypectomy,EMR and ESD(ESD with snare and standard ESD)were retrospectively analyzed. The size, en bloc resection rate, curative resection rate, procedure time,associated complications and recurrence rate were compared among groups. Results Eleven pedunculated lesions were treated with polypectomy or EMR, which were en bloc resected and curative resected with no complication or local recurrence. Nineteen semi-pedunculated lesions were treated with EMR or ESD with no complications. Lesions treated with EMR were smaller than those of ESD(P=0.026), and had a lower en bloc resection rate[77.8%(14/18)VS 1/1,P=1.000]. The difference of curative resection rate and recurrence rate between groups was not significant(P>0.05). Eighty-three sessile lesions were treated with all three procedures.Lesions treated with ESD were larger than EMR(P=0.000),with a higher curative resection rate than EMR[95.5%(42/44)VS 77.8%(28/36),P=0.041]and a longer procedure time than EMR(P=0.000). There were no significant difference in severe complications[9.1%(4/44)VS 0],en bloc resection rates and recurrence rates(P>0.05). Ten lesions treated with ESD-S had a medium size between EMR and standard ESD group, with a significant shorter procedure time than standard ESD group(36.9 ± 24.7 min VS 120.4 ± 152.3 min, P=0.004).They were en bloc resected and complete resected. Conclusion Endoscopic treatment is safe and effective for early stage colorectal carcinoma. In order to get en bloc curative resection,endoscopists should carefully choose a suitable technique based on the macroscopic morphology of lesions. ESD-S can be used as a transitional method from EMR to ESD.
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Objective To investigate the clinical features and surgical indications of subtypes of intraductal papillary mucinous neoplasm (IPMN) of the pancreas,and analyze its malignant risk factors.Methods The retrospective case-control study was conducted.The clinicopathological data of 77 patients with IPMN of the pancreas who were admitted to the First Hospital of Peking University from January 2008 to December 2016 were collected.The subtypes of IPMN of the pancreas detected by preoperative imaging examination included main-duct type (MD-IPMN) in 46 patients,branch-duct type (BD-IPMN) in 12 patients,mixed type (MT-IPMN) in 19 patients.The surgical indications were consulted from the Guideline for the diagnosis and treatment of pancreatic cystic lesions composed by the Pancreatic Surgery Group of Surgery Branch of China Medical Association.Surgical procedure was selected according to the location and size of the IPMN.Four to 6 cycles of chemotherapy with S-1 and/or Gemcitabine were conducted for patients with malignant IPMN according to the tolerance and baseline characteristics.Observation indicators included:(1) comparison of the clinical features MD-IPMN,MT-IPMN and BD-IPMN;(2) surgical and postoperative conditions;(3) results of postoperative pathological examination and malignant risk factors analysis;(4) accuracy evaluation of Sendai and Fukuoka guidelines for the diagnosis of malignant IPMN of the pancreas;(5) follow-up results and survival.Patients were followed up by outpatient examination and telephone interview till December 2016.The postoperative adjuvant therapy,tumor recurrence and metastasis of malignant IPMN patients and postoperative survival condition of all the patients were collected.Measurement data with normal distribution were expressed as (x)±s or average (range),and pairwise comparison was analyzed by t test.Measurement data with skewed distribution were expressed by median (range).Comparison between count data and univariate analysis were done by chi-square test.Multiple factors analysis was done by Logistic regTession model.The survival curve was drawn and the survival rate were calculated by Kaplan-Meier method.The comparison of survival was done by Log-rank test.Results (1) Comparison of clinical features between MD-IPMN,MT-IPMN and BD-IPMN:The numbers of patients with symptoms,jaundice,those complicated with diabetes and elevated CA19-9 were 55,20,43 and 28 in MD-IPMN and MT-IPMN,and 6,0,3 and 1 in BD-IPMN,with statistically significant difference (x2=5.421,3.516,5.525,3.834,P＜0.05).(2) Surgical and postoperative conditions:the operations for all the 77 patients were successfully done,including pancreaticoduodenectomy with or without preservation of pylorus on 45 patients,resection of head of pancreas with duodenum preservation on 3 patients,distal pancreatectomy on 23 patients,distal pancreatectomy combined with partial resection of spleen and stomach on 2 patients (with greater curvature of stomach involvement),segmental pancreatectomy on 2 patients,total pancreatectomy on 2 patients.A total of 26 surgery-related complications were detected,including pancreatic fistulas (13),delayed gastric emptying (9),wound infection (2),abdominal hemorrhage (2),and all the complications were improved by conservative treatment.There was no perioperative mortality.The mean duration of hospital stay of the 77 patients was 16 days (range,6-68 days).(3) Results of postoperative pathological examination and malignant risk factor analysis:① results of postoperative pathological examination:no residual tumor was detected at the resection margin in all the 77 patients,including 47 with benign IPMN (29 with adenoma and 18 with mid-severe atypical hyperplasia and without lymph node involvement) and 30 with malignant IPMN (all of them were invasive malignancy,including 17 patients with negative lymph node metastasis and 13 with positive lymph node metastasis).② Malignant risk factor analysis of IPMN:multivariate analysis showed that age,jaundice,elevated carcinoembryonic antigen (CEA),elevated CA19-9,tumor diameter,tumor subtypes were associated with malignancy (x2 =6.531,14.755,10.243,12.062,6.416,6.143,P ＜ 0.05).Multivariate analysis showed that jaundice,elevated CEA,elevated CA19-9,tumor diameter ≥3.0 cm,MD-IPMN were independent risk factors influencing the malignancy of IPMN (OR =9.656,42.853,23.243,34.387,69.883,95％ confidence interval:1.392-66.968,2.088-879.674,2.991-180.628,3.313-356.878,1.247-3 915.467,P＜0.05).(4) Accuracy evaluation of the Sendai and Fukuoka guidelines in diagnosis of malignant IPMN.The sensitivity,specificity,positive and negative predictive values were 100.0％(30/30),14.9％ (7/47),42.9％ (30/70) and 100.0％ (7/7) for the Sendai guideline and 86.7％ (26/30),48.9％ (23/47),52.0％ (26/50),85.2％ (23/27) for the Fukuoka guideline in diagnosis of malignant IPMN,with no significant difference in the sensitivity between the 2 guidelines (x2=2.250,P＞0.05),while significant difference in the specificity between the 2 guidelines were detected (x2 =12.500,P＜0.05).(5) Follow-up and survival:Seventy of 77 patients were followed up,including 42 with benign IPMN and 28 with malignant IPMN.The median survival time was 35.0 months (range,6.0-94.0 months).All the malignant IPMN patients received adjuvant therapy.The 1-,3-,5-year overall survival rates of 47 patient with benign IPMN were 100.0％,96.2％and 96.2％,respectively,and 1 patient died of cardiac infarction.The 1-,3-,5-year overall survival rates of 30 patients with malignant IPMN were 96.6％,81.8％,38.6％,respectively,and 11 patients died of tumor recurrence or metastasis with median time of tumor recurrence or metastasis of 20.5 months (6.0-61.6 months).The 1-,3-,5-year overall survival rates of 17 patients with negative lymph node metastasis were 100.0％,100.0％ and 60.0％,respectively,and the 1-,3-,5-year overall survival rates of 13 patients with positive lymph node metastasis were 91.7％,57.1％ and 0,respectively.There was statistically significant difference between patients with benign and malignant IPMN (x2 =12.530,P＜0.05).There was statistically significant difference between patients with negative lymph node metastasis and those with positive lymph node metastasis (x2 =16.977,P＜ 0.05).Conclusions Patients with MD-IPMN or MT-IPMN are more vulnerable to be complicated with diabetes,jaundice,elevated CA19-9 and high malignancy,and thus surgery is recommended.Jaundice,elevated CEA and CA19-9,tumor diameter≥3.0 cm,MD-IPMN are the independent risk factors influencing the malignancy of IPMN.
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Objective To investigate the clinical features and surgical indications of subtypes of intraductal papillary mucinous neoplasm (IPMN) of the pancreas,and analyze its malignant risk factors.Methods The retrospective case-control study was conducted.The clinicopathological data of 77 patients with IPMN of the pancreas who were admitted to the First Hospital of Peking University from January 2008 to December 2016 were collected.The subtypes of IPMN of the pancreas detected by preoperative imaging examination included main-duct type (MD-IPMN) in 46 patients,branch-duct type (BD-IPMN) in 12 patients,mixed type (MT-IPMN) in 19 patients.The surgical indications were consulted from the Guideline for the diagnosis and treatment of pancreatic cystic lesions composed by the Pancreatic Surgery Group of Surgery Branch of China Medical Association.Surgical procedure was selected according to the location and size of the IPMN.Four to 6 cycles of chemotherapy with S-1 and/or Gemcitabine were conducted for patients with malignant IPMN according to the tolerance and baseline characteristics.Observation indicators included:(1) comparison of the clinical features MD-IPMN,MT-IPMN and BD-IPMN;(2) surgical and postoperative conditions;(3) results of postoperative pathological examination and malignant risk factors analysis;(4) accuracy evaluation of Sendai and Fukuoka guidelines for the diagnosis of malignant IPMN of the pancreas;(5) follow-up results and survival.Patients were followed up by outpatient examination and telephone interview till December 2016.The postoperative adjuvant therapy,tumor recurrence and metastasis of malignant IPMN patients and postoperative survival condition of all the patients were collected.Measurement data with normal distribution were expressed as (x)±s or average (range),and pairwise comparison was analyzed by t test.Measurement data with skewed distribution were expressed by median (range).Comparison between count data and univariate analysis were done by chi-square test.Multiple factors analysis was done by Logistic regTession model.The survival curve was drawn and the survival rate were calculated by Kaplan-Meier method.The comparison of survival was done by Log-rank test.Results (1) Comparison of clinical features between MD-IPMN,MT-IPMN and BD-IPMN:The numbers of patients with symptoms,jaundice,those complicated with diabetes and elevated CA19-9 were 55,20,43 and 28 in MD-IPMN and MT-IPMN,and 6,0,3 and 1 in BD-IPMN,with statistically significant difference (x2=5.421,3.516,5.525,3.834,P＜0.05).(2) Surgical and postoperative conditions:the operations for all the 77 patients were successfully done,including pancreaticoduodenectomy with or without preservation of pylorus on 45 patients,resection of head of pancreas with duodenum preservation on 3 patients,distal pancreatectomy on 23 patients,distal pancreatectomy combined with partial resection of spleen and stomach on 2 patients (with greater curvature of stomach involvement),segmental pancreatectomy on 2 patients,total pancreatectomy on 2 patients.A total of 26 surgery-related complications were detected,including pancreatic fistulas (13),delayed gastric emptying (9),wound infection (2),abdominal hemorrhage (2),and all the complications were improved by conservative treatment.There was no perioperative mortality.The mean duration of hospital stay of the 77 patients was 16 days (range,6-68 days).(3) Results of postoperative pathological examination and malignant risk factor analysis:① results of postoperative pathological examination:no residual tumor was detected at the resection margin in all the 77 patients,including 47 with benign IPMN (29 with adenoma and 18 with mid-severe atypical hyperplasia and without lymph node involvement) and 30 with malignant IPMN (all of them were invasive malignancy,including 17 patients with negative lymph node metastasis and 13 with positive lymph node metastasis).② Malignant risk factor analysis of IPMN:multivariate analysis showed that age,jaundice,elevated carcinoembryonic antigen (CEA),elevated CA19-9,tumor diameter,tumor subtypes were associated with malignancy (x2 =6.531,14.755,10.243,12.062,6.416,6.143,P ＜ 0.05).Multivariate analysis showed that jaundice,elevated CEA,elevated CA19-9,tumor diameter ≥3.0 cm,MD-IPMN were independent risk factors influencing the malignancy of IPMN (OR =9.656,42.853,23.243,34.387,69.883,95％ confidence interval:1.392-66.968,2.088-879.674,2.991-180.628,3.313-356.878,1.247-3 915.467,P＜0.05).(4) Accuracy evaluation of the Sendai and Fukuoka guidelines in diagnosis of malignant IPMN.The sensitivity,specificity,positive and negative predictive values were 100.0％(30/30),14.9％ (7/47),42.9％ (30/70) and 100.0％ (7/7) for the Sendai guideline and 86.7％ (26/30),48.9％ (23/47),52.0％ (26/50),85.2％ (23/27) for the Fukuoka guideline in diagnosis of malignant IPMN,with no significant difference in the sensitivity between the 2 guidelines (x2=2.250,P＞0.05),while significant difference in the specificity between the 2 guidelines were detected (x2 =12.500,P＜0.05).(5) Follow-up and survival:Seventy of 77 patients were followed up,including 42 with benign IPMN and 28 with malignant IPMN.The median survival time was 35.0 months (range,6.0-94.0 months).All the malignant IPMN patients received adjuvant therapy.The 1-,3-,5-year overall survival rates of 47 patient with benign IPMN were 100.0％,96.2％and 96.2％,respectively,and 1 patient died of cardiac infarction.The 1-,3-,5-year overall survival rates of 30 patients with malignant IPMN were 96.6％,81.8％,38.6％,respectively,and 11 patients died of tumor recurrence or metastasis with median time of tumor recurrence or metastasis of 20.5 months (6.0-61.6 months).The 1-,3-,5-year overall survival rates of 17 patients with negative lymph node metastasis were 100.0％,100.0％ and 60.0％,respectively,and the 1-,3-,5-year overall survival rates of 13 patients with positive lymph node metastasis were 91.7％,57.1％ and 0,respectively.There was statistically significant difference between patients with benign and malignant IPMN (x2 =12.530,P＜0.05).There was statistically significant difference between patients with negative lymph node metastasis and those with positive lymph node metastasis (x2 =16.977,P＜ 0.05).Conclusions Patients with MD-IPMN or MT-IPMN are more vulnerable to be complicated with diabetes,jaundice,elevated CA19-9 and high malignancy,and thus surgery is recommended.Jaundice,elevated CEA and CA19-9,tumor diameter≥3.0 cm,MD-IPMN are the independent risk factors influencing the malignancy of IPMN.
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<p><b>OBJECTIVE</b>To analyze the clinical efficacy of endoscopic therapy for early colorectal cancer.</p><p><b>METHODS</b>Clinical data of 113 early colorectal mucosal carcinoma or submucosal carcinoma receiving endoscopic therapy were retrospectively analyzed and compared with 39 early colorectal cancer cases receiving surgery during the same time.</p><p><b>RESULTS</b>All the cases were well-moderately differentiated adenocarcinoma. Size of tumors in endoscopic group was (26.2±21.5) mm, and that was (30.9±24.3) mm in surgery group (P=0.257). Baseline data between the two groups were not significantly different (all P>0.05). Significantly shorter median operating time [15.0 minutes vs. 203.0 minutes, χ=69.322, P=0.000] and median hospital stay [3.0 days vs. 17.0 days, χ=76.180, P=0.000] were observed in endoscopic group compared with surgery group. The en bloc resection rate, curative resection rate, lymph node metastatic rate and complication rate were not significantly different between two groups (all P>0.05). Ten patients in endoscopic group were referred to additional surgery for deep invasion and/or incomplete resection, of whom 7 received radical surgery, and the other 3 cases without radical surgery did not develop recurrence during follow-up of (20.5±0.9) months. After follow-up for (17.5±15.8) months, the local recurrence rate was 5.3% (6/113) in endoscopic group and 0 (0/39) in surgery group without significant difference (χ=0.983, P=0.321). There was no significant difference in 5-year tumor-free survival rate between two groups (91.8% vs. 97.0%, χ=1.533, P=0.216).</p><p><b>CONCLUSION</b>Endoscopic therapy possesses shorter operating time, shorter hospital stay and similar efficacy as compared to surgery in the treatment of early colorectal cancer.</p>