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The surgical treatment principle of colorectal cancer has always been to remove the intestine with tumor locating and the adjacent mesentery. However, the optimal area of mesen-tery resection and the optimal range of lymph node dissection are still controversial. At present, there are two main theories of lymph node metastasis of colorectal cancer, including the Halsted metastasis model and the Fisher metastasis model. The Halsted metastasis model indicates that the tumor always metastasizing from the primary focus to the paraintestinal lymph nodes, then to the intermediate lymph nodes, central lymph nodes, and finally distant metastasis. The Fisher metas-tasis model, on the other hands, suggests that tumor metastasis may occurring in the early stage of tumor and may be random events. If Fisher′s model is established, lymph node dissection in traditional colorectal cancer surgery is only a step to determine the tumor stage, which is unlikely to affect the prognosis of cancer patients. The latest research data shows that lymph node metastasis and liver metastasis of colorectal cancer originating from different cell subsets of primary tumor, and the circulating tumor cells and its DNA can be detected in early stage of colorectal cancer. Therefore, the diagnosis and treatment of colorectal cancer has moved towards to the biology-based surgery. The biology-based surgery refers to the implementation of surgical treatment according to the results of tumor gene analysis or molecular immunoassay while making accurate diagnosis, so as to improve the prognosis and quality of life of patients by changing the timing, indications and methods of surgery. More and more biological and clinical research evidences are applied to guide the surgical timing and operation mode of colorectal cancer. Based on clinical practice and literature analysis, the authors believe that the biology-based surgery of colorectal cancer is still in its infancy, and with the development of gene sequencing technology and the revelation of the pathogenesis of colorectal cancer, the biology-based surgery will play a more important role in colorectal cancer.
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Objective:To investigate clinicopathological characteristics and efficacy of conversion therapy in patients with metastatic gastric cancer.Methods:The clinicopathological and follow-up data of metastatic gastric cancer patients at the Department of Gastrointestinal Surgery of Peking University People's Hospital from Jan 2018 to Jun 2021 were retrospectively studied. Multivariate Logistic regression analysis was used to identify independent characteristics for pathological complete response (PCR). The influence of stage of metastatic gastric cancer and pathological response on prognosis were analyzed by Kaplan-Meier curve.Results:A total of 31 patients were enrolled, and 13 tumors located at the cardia or fundus, 8 at body, other 10 at pylorus or antrum . Baseline CT evaluation showed retroperitoneal lymph node metastasis in 10 cases, intraperitoneal metastasis in 10 cases, liver metastasis in 2 cases, adrenal and splenic metastasis in 1 case respectively, and multiple metastasis in 5 cases. After conversion therapy, 8 (26%) cases had pathological T0, 16 cases (52%) had pathological N0 and 7 cases (22%) had pathological complete response. Multivariate Logistic regression analysis showed retroperitoneal lymph node metastasis ( OR: 20.082, 95% CI: 2.141-188.315, P=0.009) was the only independent risk factor of PCR. Meanwhile, Kaplan-Meier curve showed pT0 improved disease-free survival significantly ( P=0.021). Conclusions:Metastatic gastric cancer patients with retroperitoneal lymph node metastasis alone had a tolerable conversion therapy effect. pT0 is a significant factor in improving prognosis.
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Objective:To observe the clinical characteristics of esophageal reflux after total gastrectomy (ERATG), and to explore the mechanism of occurrence.Methods:Fourteen gastric cancer patients who underwent total gastrectomy were prospectively enrolled in this study. The postoperative symptoms were observed and recorded and 24 h MII-pH with pH monitoring was performed to investigate the characteristics of postoperative reflux.Results:After total gastrectomy patients were with different degrees of ERATG as heartburn, appetite loss, chest tightness and belching. The overall nature of ERATG is mainly weak acid, with a pH between 4 and 7. ERATG involved esophageal-jejunal anastomosis and a length of esophagus 7 cm above the anastomosis. Patients with typical reflux symptoms had a lower pH minimum in the upright position than those without typical symptoms[(4.76±0.71) vs.(5.68±0.37), t=2.866, P<0.05]. Patients with typical reflux symptoms had a higher frequency of reflux of mixed liquid and liquid-air reflux than those without typical symptoms[liquid(31.25±29.76) vs.(4.50±9.14), t=0.011, P<0.05; liquid-air(19.50±12.99) vs.(2.00±2.61), t=0.004, P<0.05]. Conclusion:ERATG is mainly a upward reflux of weakly acidic gas, with typical symptoms of heartburn, appetite loss, chest tightness and belching. Patients with typical symptoms usually have lower pH in the upright position.
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With certain advantages of superior surgical fields and better chances for anus reservation,transanal total mesorectal excision (TaTME) is a novel surgical approach for low rectal cancer.Guidelines recommend muhidisciplinary team (MDT) work as a clinical routine for standardized treatment of rectal cancer.Indication of TaTME depends on multidisciplinary discussion including preoperative staging,prediction of recurrence risks.Standardized preoperative evaluation by MDT and decisions after MDT discussion are the guarantee for the startdardized implementation and reasonable promotion of TaTME.Meanwhile,as a procedure for improving local efficacy of rectal cancer,TaTME could save a part of patients with low rectal cancer the trouble of neoadjuvant chemoradiotherapy based on accurate staging by radiologists.That might upgrade status of colorectal.surgeons in the MDT and contribute to optimize both curative effects and health economics.
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With certain advantages of superior surgical fields and better chances for anus reservation, transanal total mesorectal excision (TaTME) is a novel surgical approach for low rectal cancer. Guidelines recommend multidisciplinary team (MDT) work as a clinical routine for standardized treatment of rectal cancer. Indication of TaTME depends on multidisciplinary discussion including preoperative staging, prediction of recurrence risks. Standardized preoperative evaluation by MDT and decisions after MDT discussion are the guarantee for the stan-dardized implementation and reasonable promotion of TaTME. Meanwhile, as a procedure for improving local efficacy of rectal cancer, TaTME could save a part of patients with low rectal cancer the trouble of neoadjuvant chemoradiotherapy based on accurate staging by radiologists. That might upgrade status of colorectal surgeons in the MDT and contribute to optimize both curative effects and health economics.
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Objective To investigate the influence of mismatch repair status on clinicopathological characteristics and prognosis in patients with colon cancer.Methods Patients who underwent radical excision for colon cancer between Nov 2012 and Mar 2016 at Peking University People's Hospital were enrolled.Clinicopathological data and prognosis were collected.Multivariate analysis were used to identify independent characteristics of MMR-deficient colon cancer.The influence of MMR-deficient on prognosis of colon cancer were analyzed through Kaplan-Meier curve.Results The overall rate of MMR-deficient in colon cancer was 17.1％ (51/299).Multivariate logistic regression analysis showed that low differentiation (OR =3.555,95％ CI:1.685-7.640,P ＜ 0.001),right-sided colon cancer (OR =5.645,95％ CI:2.483-14.715,P ＜ 0.001) and UICC Stage Ⅰ-Ⅱ (OR =4.099,95％ CI:1.863-9.840,P ＜0.001) were associated with MMR-deficient colon cancer.Conclusion Low differentiation,right-sided colon cancer and UICC Stage Ⅰ-Ⅱ were more common in MMR-deficient colon cancer.
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Objective To evaluate the efficacy of the new treatment regimen versus the standardized scheme for the initial treatment of smear-positive tuberculosis in the elderly.Methods A total of 302 elderly patients meeting the inclusion and exclusion criteria were selected from 14 tuberculosis-designated medical institutions in Beijing.The patients received the initial treatment of smear-positive tuberculosis from January 2014 to August 2016 in the combined prospective and retrospective study.All patients were divided into observation group(n=63)receiving treatment with 6L2 HELfx regimen from August 1,2015 to August 31,2016,and control group (n =239) receiving treatment with 6L2HELfx regimen from January 1,2014 to January 31,2015.The nation-unified standard chemotherapy regimen 2RHZE/4RH was used in tuberculosis medical service institutions for all patients.The differences between the two groups were analyzed and compared in the completion of treatment,negative conversion of sputum culture or smear,adverse drug reactions and treatment outcome.Results The completion rate of long-course therapy was significantly higher in the observation group than in control group [90.5％ (57/63) vs.79.5％ (190/239),x2 =4.034,P =0.045].The rate of negative conversion of sputum culture or smear at the end of the 2nd month was higher in the observation group than in control group,but had no significant difference[87.0％ (47/54)vs.81.6％(155/190),x2 =0.879,P=0.349].The incidence of adverse reactions was much lower in observation group than in control group[46.0％ (29/63) vs.65.3％ (156/239),x2 =7.777,P =0.005].The success rate of treatment(cure or completion of long-course therapy)was higher in observation group than in control group [90.5％ (57/63) vs.77.4％ (185/239),x2 =5.350,P =0.021].ConclusioNS As compared with the standard chemotherapy regimen,the L and Lfxcontaining treatment regimen has better effects,higher success rate of treatment and less adverse reactions in elderly patients with the initial treatment of smear-positive tuberculosis.
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Acute intestinal obstruction is one of the common causes of emergency surgery in patients with colorectal cancer,which is usually with poor prognosis. Surgery is the most important way to relieve obstruction and save the lives. One-stage resection and anastomosis can completely remove the tumor, restore the continuity of the intestine, avoid complications of staged surgery and reduce disease burden,and is supposed to be the most ideal surgery. However,due to certain intraoperative technical difficulties and the risk of anastomotic leakage,it is still controversial whether the one-stage resection and anastomosis surgery can be preferred during emergency exploration.
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Objective@#To compare the efficacy and safety of two procedures in the treatment of hemorrhoid: the procedure for prolapse and hemorrhoids (PPH) and stapled transanal rectal resection (STARR).@*Methods@#A retrospective cohort research was conducted. Clinical data of 263 patients undergoing the first elective surgery for grade IV hemorrhoids by the same team of surgeons at our department from January 2015 to December 2016 were analyzed retrospectively, while those had other anorectal diseases, emergency surgery, inflammatory bowel disease, tumor and incomplete clinical data were excluded. PPH was performed in 129 patients and STARR was performed in 134 patients. PPH procedure: a circular purse 2-0 string suture was made at 4 cm above the dentate line; in accordance with the standard protocol, the PPH circular stapling devicewas introduced; the suture was closed, and a pull-through followed; the traction was continued; the stapler was fired; the prolapsed mucosa and submucosa were removed. STARR procedure: 3-5 needles were sutured in the anterior rectal mucosa, protecting the posterior wall mucosa; with the help of a finger the PPH stapler was inserted into the vaginal lumen; the sutures were hooked from both sides of the stapler to maintain traction; according to the disease condition, the suturewas tightened appropriately; stapler was screwed and activated; the anterior wall mucosa was removed; the joint of the both ends of anastomosis was cut; the posterior wall mucosa was removed as well. The short-term efficacy, surgical safety and prognosis of the two groups were compared.@*Results@#There were 67 males (51.9%) in the PPH group and 57 (42.5%) males in the STARR group. The median age of the two groups was 51.0 (22.0, 80.0) years and 49.0 (24.0, 74.0) years, respectively. There were no significant differences in the baseline data between the two groups (all P>0.05). No significant differences in the intraoperative bleeding, length of hospital stay, postoperative analgesic drug use, postoperative bleeding, postoperative infection, etc. were found between two groups (all P>0.05). As compared to PPH group, STAAR group had longer operation time and higher hospitalization cost with significant differences [(44.0±19.3) minutes vs. (26.3±8.5) minutes, t=9.701, P=0.001; (11 047±473) yuan vs. (7674±309) yuan, t=32.826, P=0.001]. One case in STAAR group developed rectovaginal fistula. The median follow-up period of the whole group was 40 (33, 52) months. A total of 108 cases in STARR group and 114 cases in PPH group completed the follow-up. The 3-year disease-relapse rate was 0 in STARR group and 4.2% in PPH group (P=0.042).@*Conclusion@#STARR procedure can improve the prognosis in the treatment of grade IV hemorrhoid, but attention should be paid to the development of complications.
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Neoadjuvant therapy has become an indispensable part of the treatment in locally advanced mild-low rectal cancer. Neoadjuvant therapy can cause the regression of the tumor body as well as drainage lymph nodes, which may influence the size, number, and metastatic status of the lymph nodes. In clinical practice, the total number of lymph nodes detected in rectal cancer treated with neoadjuvant therapy were significantly decreased, making it difficult to meet the standard of the NCCN guideline that at least 12 regional lymph nodes should be harvested. The optimal detection of yielded lymph nodes in rectal cancer is essential for accurate staging, response assessment, and adjuvant treatment decision. The lymph node diameter is significantly reduced after neoadjuvant therapy in locally advanced rectal cancer. In general, the number of detected lymph nodes is significantly reduced without additional pathological examination. The detected lymph nodes would increase by deliberate pathological examination, improvement of the detection method, or using a lymph node tracer. However, whether the number of detected lymph nodes is still needed to meet the requirements of the NCCN guideline, and the relationship between the number of detected lymph nodes and the prognosis are still controversial. At present, the number of negative lymph nodes, LNR, LODDS, etc. can be also used to predict prognosis in addition to ypN staging. For patients with ypN0 and ypN+ stage, different evaluation methods can be selected. For patients with ypN0, the number of detected lymph nodes still has important clinical significance for the prognosis and treatment decision. This article will introduce the related issues, and provide more evidence-based diagnosis and treatment practice.
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Objectives@#To study the significance of SATB2 expression in colon adenocarcinoma and its differential diagnosis function for ovarian metastatic adenocarcinoma.@*Methods@#Immunohistochemistry was used to detect the expression level of SATB2 in 130 cases of colon adenocarcinoma. The relationship between the positive rate of SATB2 expression in colon cancer and clinicopathological factors was studied. Forty-seven cases of pancreatic ductal adenocarcinoma, 22 cases of cholangiocarcinoma, 46 cases of gastric adenocarcinoma, and 53 cases of ovarian mucinous adenocarcinoma were studied respectively.@*Results@#The positive expression rate of SATB2 in 130 cases of colon adenocarcinoma is 73.8%. The SATB2 expression bears no correlation with gender, age, tumor size, location, histology type, lymph node metastasis, staging, local recurrence, distant metastasis, survival, Kras mutation, and microsatellite stability. The expression rate of SATB2 is significantly higher in well differentiated and moderately differentiated colon adenocarcinoma than that in poorly differentiated adenocarcinoma (χ2=12.804, P=0.002); the expression rate in the cases without tumor deposit is significantly higher than in cases with tumor deposit (χ2=6.485, P=0.011). There was no positive expression in all cases of pancreatic adenocarcinoma, cholangiocarcinoma, gastric adenocarcinoma, nor in ovarian mucinous adenocarcinoma.@*Conclusion@#The expression of SATB2 is associated with the differentiation of colon adenocarcinoma and the formation of tumor deposit. SATB2 can be used as an effective tumor marker for identifying colorectal cancer ovarian metastases.
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Objectives To study the significance of SATB2 expression in colon adenocarcinoma and its differential diagnosis function for ovarian metastatic adenocarcinoma.Methods Immunohistochemistry was used to detect the expression level of SATB2 in 130 cases of colon adenocarcinoma.The relationship between the positive rate of SATB2 expression in colon cancer and clinicopathological factors was studied.Forty-seven cases of pancreatic ductal adenocarcinoma,22 cases of cholangiocarcinoma,46 cases of gastric adenocarcinoma,and 53 cases of ovarian mucinous adenocarcinoma were studied respectively.Results The positive expression rate of SATB2 in 130 cases of colon adenocarcinoma is 73.8％.The SATB2 expression bears no correlation with gender,age,tumor size,location,histology type,lymph node metastasis,staging,local recurrence,distant metastasis,survival,Kras mutation,and microsatellite stability.The expression rate of SATB2 is significantly higher in well differentiated and moderately differentiated colon adenocarcinoma than that in poorly differentiated adenocarcinoma (x2 =12.804,P =0.002);the expression rate in the cases without tumor deposit is significantly higher than in cases with tumor deposit (x2 =6.485,P =0.011).There was no positive expression in all cases of pancreatic adenocarcinoma,cholangiocarcinoma,gastric adenocarcinoma,nor in ovarian mucinous adenocarcinoma.Conclusion The expression of SATB2 is associated with the differentiation of colon adenocarcinoma and the formation of tumor deposit.SATB2 can be used as an effective tumor marker for identifying colorectal cancer ovarian metastases.
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Objective To analyze the spatial distribution and identify the high risk areas of pulmonary tuberculosis at the township level in Beijing during 2005-2015.Methods Data on pulmonary tuberculosis cases was collected from the tuberculosis information management system.Global autocorrelation analysis,local indicators of spatial association and Kulldorff's Scan Statistics were applied to map the spatial distribution and detect the space-time clusters of the pulmonary tuberculosis cases during 2005-2015.Results Spatial analysis on the incidence of pulmonary tuberculosis at the township level demonstrated that the spatial autocorrelation was positive during the study period.The values of Moran's I ranged from 0.224 3 to 0.291 8 with all the P values less than 0.05.Hotspots were primarily distributed in 8 towns/streets as follows:Junzhuang,Wangping,Yongding and Tanzhesi in Mentougou district,Yancun in Fangshan district,Wangzuo town in Fengtai district,Tianqiao street in Xicheng district and Tianzhu town in Shunyi district.Spatiotemporal clusters across the entire study period were identified by using Kulldorff's spatiotemporal scan statistic.The primary cluster was located in Chaoyang and Shunyi districts,including 17 towns/streets,as follows:Cuigezhuang,Maizidian,Dongfeng,Taiyanggong,Zuojiazhuang,Hepingjie,Xiaoguan,Xiangheyuan,Dongba,Jiangtai,Wangjing,Jinzhan,Jiuxianqiao,Laiguangying,Sunhe towns/streets in Chaoyang district,Houshayu and Tianzhu town in Shunyi district,during January to December 2005.Conclusion Incidence rates of pulmonary tuberculosis displayed spatial and temporal clusterings at the township level in Beijing during 2005-2015,with high risk areas relatively concentrated in the central and southern parts of Beijing.
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Objective To analyze the spatial distribution and identify the high risk areas of pulmonary tuberculosis at the township level in Beijing during 2005-2015.Methods Data on pulmonary tuberculosis cases was collected from the tuberculosis information management system.Global autocorrelation analysis,local indicators of spatial association and Kulldorff's Scan Statistics were applied to map the spatial distribution and detect the space-time clusters of the pulmonary tuberculosis cases during 2005-2015.Results Spatial analysis on the incidence of pulmonary tuberculosis at the township level demonstrated that the spatial autocorrelation was positive during the study period.The values of Moran's I ranged from 0.224 3 to 0.291 8 with all the P values less than 0.05.Hotspots were primarily distributed in 8 towns/streets as follows:Junzhuang,Wangping,Yongding and Tanzhesi in Mentougou district,Yancun in Fangshan district,Wangzuo town in Fengtai district,Tianqiao street in Xicheng district and Tianzhu town in Shunyi district.Spatiotemporal clusters across the entire study period were identified by using Kulldorff's spatiotemporal scan statistic.The primary cluster was located in Chaoyang and Shunyi districts,including 17 towns/streets,as follows:Cuigezhuang,Maizidian,Dongfeng,Taiyanggong,Zuojiazhuang,Hepingjie,Xiaoguan,Xiangheyuan,Dongba,Jiangtai,Wangjing,Jinzhan,Jiuxianqiao,Laiguangying,Sunhe towns/streets in Chaoyang district,Houshayu and Tianzhu town in Shunyi district,during January to December 2005.Conclusion Incidence rates of pulmonary tuberculosis displayed spatial and temporal clusterings at the township level in Beijing during 2005-2015,with high risk areas relatively concentrated in the central and southern parts of Beijing.
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Gastric stump cancer(GSC) is defined as newly developed remnant stomach cancer following gastrectomy. This definition initially referred to carcinoma detected in the remnant stomach more than 5 years after the primary surgery for a benign disease. Subsequently, this timeframe was extended to 10 years after the primary surgery for a malignant disease. Recently, the concept of "carcinoma in the remnant stomach(CRS)" proposed by the Japanese Gastric Cancer Association was introduced in China. The new definition encompasses all carcinomas arising in the remnant stomach following gastrectomy, irrespective of the histology of the primary lesion, extent of resection, or reconstruction method. It includes all carcinoma types that have developed in the remnant stomach, such as newly developed cancer, recurrent cancer, remaining cancer, and multiple cancers. Considering the current diagnosis and treatment status of gastric cancer in China, if CRS is to be used as a direct equivalent to GSC in clinical practice, confusion may arise concerning disease identification and diagnosis. Following several discussion rounds, a meta-analysis of the literatures at home and abroad, and a multicenter national retrospective study with a large sample population, the "Chinese surgeons' consensus opinion for the definition of gastric stump cancer (version 2018)" was completed. By reviewing the detailed evidence-based medicine supporting the consensus document, this paper aims to assist clinical diagnosis and enhance future academic exchange.
Subject(s)
Humans , China , Consensus , Gastrectomy , Gastric Stump , Pathology , General Surgery , Neoplasm Recurrence, Local , Retrospective Studies , Stomach Neoplasms , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To explore the prognostic value of the tumor-ratio-metastasis (TRM) staging system for carcinoma in the remnant stomach(CRS).</p><p><b>METHODS</b>Clinicopathological data of 91 CRS patients who underwent surgery at Peking University People's Hospital between March 1992 and December 2017 were retrospectively analyzed. According to the ratio of metastatic lymph node to dissected lymph node, the R staging was obtained, and the pN staging was replaced by the R staging to create the TRM staging. To compare the predictive accuracy of TRM and tumor-node-metastasis (TNM, UICC version 7), the R staging and pN staging were included in the prognostic factor analysis model, and the survival curve, c-index, and 95% confidence interval (CI) of the TRM staging and TNM staging system were compared. A higher c-index value means higher prediction accuracy.</p><p><b>RESULTS</b>Of 91 CRS patients, 77 were male and 14 were female with the mean onset age of (65.2±10.4) years. The mean interval from the first operation to CRS onset was 156(6-600) months. The primary diseases of 49(53.8%) cases were benign and of 42(46.2%) cases were malignant. The median number of retrieved lymph node (RLN) was 8 (0-38), and 64 patients (70.3%) had an RLN ≤15. Lymph node metastasis occurred in 50 patients (54.9%). pN staging result was as follows: 41 cases in N0 stage, 14 in N1 stage, 19 in N2 stage, and 17 in N3 stage. R staging result was as follows: 41 cases in R0 stage, 4 in R1 stage, 19 in R2 stage, and 27 in R3 stage. TNM staging result was as follows: 13 cases in stage I(, 25 in stage II(, 10 in stage III(a, 23 in stage III(b, and 6 in stage III(c. TRM staging result was as follows: 13 cases in stage I(, 24 in stage II(, and 4 in stage III(a, 18 in stage III(b, and 18 in stage III(c. Univariate analysis showed that tumor diameter ≥7 cm (HR=2.696, 95%CI: 1.307-5.563, P=0.007), T3-4 stage (HR=4.350, 95%CI: 1.949-9.707, P=0.000), N2-3 stage (HR=1.883, 95%CI: 1.167-3.038, P=0.009), R2-3 stage (HR=1.642, 95%CI: 1.026-2.628, P=0.039), TNM III(-IIII( stage (HR=2.448, 95%CI:1.490-4.021, P=0.000), and TRM III(-IIII( stage (HR=2.504, 95%CI:1.515-4.137, P=0.000) were related to prognosis. Tumor diameter, pT staging, and pN staging were included in the Cox multivariate analysis, and the result showed that pT staging (HR=5.507, 95%CI:2.254-13.454, P=0.000) and pN staging (HR=1.698, 95%CI: 1.022-2.789, P=0.041) were independent risk factors for overall survival of CRS in this group. While R staging replaced pN staging and was included in the Cox multivariate analysis together with tumor diameter and pT staging, the result showed that R staging was not an independent risk factor for CRS in this group (HR=1.622, 95%CI: 0.866-2.329, P=0.164). Survival curve revealed pN and TNM staging systems provided better stratified curves according to each staging than R and TRM staging systems. The overall survival c-index of TNM and TRM staging systems was 0.813(95%CI: 0.732-0.826) and 0.809(95%CI: 0.741-0.847) respectively, and no significant difference in predictive accuracy was found (P=0.693). In 42 patients with primary malignance, the overall survival c-index of TNM and TRM staging systems was 0.774(95%CI: 0.589-0.901) and 0.761(95%CI: 0.596-0.912) respectively, and there was no significant difference in predictive accuracy as well (P=0.881).</p><p><b>CONCLUSION</b>TRM staging is not superior to TNM staging (7th UICC) in evaluating the resected samples of CRS.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Gastric Stump , Pathology , General Surgery , Lymph Nodes , Lymphatic Metastasis , Neoplasm Staging , Prognosis , Retrospective Studies , Stomach Neoplasms , Pathology , General Surgery , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To study the clinicopathological features and prognosis of gastric stump cancer (GSC) following subtotal gastrectomy for gastric cancer, to compare the clinicopathologic differences between narrow GSC and generalized GSC, and to compare the prognosis between GSC and primary proximal gastric cancer (PPGC) after radical resection.</p><p><b>METHODS</b>Literatures of GSC-associated clinical study were searched by computer from the Cochrane Library, Medline, PubMed, CNKI, Wanfang and VIP databases, and the retrieval period was from the establishment of database to December 31, 2017.</p><p><b>INCLUSION CRITERIA</b>(1) GSC was defined as a carcinoma arising in the gastric remnant after radical gastrectomy for gastric cancer, and confirmed by the pathological or histological examination, the elapsed time from the initial operation was not considered in the definition. (2) Retrospective or prospective clinical cohort study. (3) Study included at least one of below items: gender, anastomotic type in gastric cancer surgery, the interval between the initial surgery and diagnosis of GSC, the location, treatment, pathological differentiation, pathologic stage, lymph node metastasis rate and prognosis of GSC. (4) When similar studies were reported by the same institution or author, either the better quality study or the newest publication was chosen.</p><p><b>EXCLUSION CRITERIA</b>(1) Abstracts, reviews, case reports, meeting record, editorials and repeated research. (2) Studies including patients with initial non-gastric cancer. In this study, gastric stump cancer(GSC) after gastric cancer was divided into two groups: the incidence without limit interval time (generalized GSC group) and above 10 years (narrow GSC group). Selective trials were Meta-analyzed by the Stata13.0 software and statistical analysis was performed using SPSS 21.0 software.</p><p><b>RESULTS</b>A total of 27 literatures were finally enrolled, which comprised 1463 GSC patients, including 1146 males and 317 females. The generalized group and narrow GSC group had 921 and 542 patients respectively. The generalized GSC group and the narrow GSC group did not significantly differ in terms of previous reconstruction mode, types of differentiation, pathologic T staging, postoperative pathology tumor-node-metastases staging, and distant metastasis rate (χ=2.341, 0.926, 0.350, 0.965, 2.311 respectively, all P>0.05). As compared to generalized GSC group, narrow GSC group had higher ratio of male patients (82.8% vs. 75.7%, χ=9.909, P=0.002), more lesions locating in anastomotic stoma (37.8% vs. 26.1%, χ=18.091, P=0.000), higher ratio of patients undergoing radical resection (84.2% vs. 70.3%, χ=11.738, P=0.001), higher positive rate of postoperative lymph node (45.8% vs. 34.5%, χ=6.319, P=0.012), and larger size of tumor [(5.9±2.2) cm vs. (4.5±1.9) cm, t=9.151, P=0.000]. The overall 5-year survival rate and postoperative pathology stage III(-IIII( survival ratio in narrow GSC group were higher compared to general GSC group (42.7% vs. 30.6% and 27.5% vs. 18.1%, respectively), which were significantly different (χ=10.938, P=0.000; χ=4.128, P=0.042), while the postoperative pathology stage I(-II( survival ratio was not significantly different between two groups (67.3% vs. 67.0% respectively, χ=0.015, P=0.92). There was no significant difference in the 5-year survival rate between GSC with radical resection and PPGC(RR=1.04, 95%CI:0.79-1.36, P=0.805) and the 5-year survival rate of same postoperative pathology stage was not significantly different between two groups (I(-II( stage: RR=1.08, 95%CI:0.93-1.26, P=0.328; III(-IIII( stage: RR=0.59, 95%CI:0.33-1.04, P=0.111).</p><p><b>CONCLUSIONS</b>There are some different clinicopathological features between the generalized and the narrow GSC after gastric cancer surgery. The prognosis of GSC after radical resection is similar to primary proximal gastric cancer.</p>
Subject(s)
Female , Humans , Male , Gastrectomy , Gastric Stump , Pathology , General Surgery , Neoplasm Staging , Prognosis , Prospective Studies , Retrospective Studies , Stomach Neoplasms , General Surgery , Survival RateABSTRACT
Gastric stump cancer (GSC) is a carcinoma arising from the remnant stomach following gastric surgery for benign or malignant disease, and is more common in men. The risk of morbidity has an obvious time dependence. GSC incidence is likely to rise with lengthening of the initial operation interval. The GSC time interval after malignant disease is significantly shorter than that of benign disease. GSC etiologies mainly include duodenogastric reflux and denervation of the gastric mucosa resulting in the change of the gastric environment after gastrectomy and the Helicobacter pylori infection. Due to atypical clinical symptoms, GSC is always identified at an advanced stage and the long-term survival rate is low. An optimal endoscopic surveillance system is essential to improve early detection rates. Treatments in GSC and primary gastric cancer are the same and include resection of the lesion and radical lymph node dissection. R0 resection is an important prognostic factor. Here we review previous reports with respect to epidemiological characteristics, etiology, clinical symptoms, treatment, and prognosis of GSC.
Subject(s)
Humans , Male , Gastrectomy , Gastric Stump , Pathology , General Surgery , Helicobacter Infections , Lymph Node Excision , Stomach Neoplasms , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the risk factors of low anterior resection syndrome (LARS) after anal sphincter preserving surgery (SPS) for rectal cancer patients.</p><p><b>METHODS</b>Clinicopathological and follow-up data of rectal cancer patients who underwent SPS from January 2010 to June 2014 in Department of Gastroenterological Surgery, Peking University People's Hospital, were retrospectively analyzed. Patients receiving permanent colostomy and local resection were excluded. Meanwhile, during October 2014 and March 2015, the enrolled patients were asked to fill out a specially designed questionnaire for LARS through face-to-face interview or telephone inquiry, according to the chronological order of operation. Based on the score of questionnaire, patients were divided into three groups: 0-20 points: non LARS; 21-29: minor LARS; 30-42: major LARS. The demographic and clinicopathologic features were compared among groups and the risk factors of major LARS were tested by logistic regression analysis.</p><p><b>RESULTS</b>A total of 100 patients (61 males, 39 females) completed the bowel function survey, with an average age of 66.2(41-86) years, 33 patients <60 years versus 67 patients ≥60 years. No significant difference was observed in age distribution (P=0.204). Interval from operation to first follow-up was more than 1 year in 70 patients, and the median follow-up was 23 months. Thirty-seven patients were non LARS, 18 were minor LARS and 45 were major LARS. No significant differences in clinicopathological data (all P>0.05) were observed among three groups except radiotherapy history (P=0.025), tumor location(P=0.000) and distance from anastomotic site to anal verge(P=0.008). After comparison of non LARS group combined with minor LARS group versus major LARS, re-analysis of risk factors showed that radiotherapy history (RR=5.608, 95%CI:1.457 to 21.584, P=0.006), distance from tumor lower margin to anal verge (RR=0.125, 95%CI:0.042 to 0.372, P=0.000), distance from anastomotic site to anal verge (RR=0.255, 95%CI:0.098 to 0.665, P=0.004) and preventive ileostomy history(RR=3.643, 95%CI:1.058 to 12.548, P=0.032) were associated with major LARS. One potential risk factor detected in combined analysis was female (RR=2.138, 95%CI: 0.944 to 4.844, P=0.078). Multivariate analysis revealed that female (RR=2.654, 95%CI: 1.005 to 7.014, P=0.049), radiotherapy history (RR=10.422, 95%CI:2.394 to 45.368, P=0.002) and distance from tumor lower margin to anal verge ≤7 cm (RR=8.935, 95%CI:2.827 to 28.243, P=0.000) were independent risk factors of major LARS.</p><p><b>CONCLUSIONS</b>LARS is a significant problem in most rectal cancer patients after SPS. The risk of major LARS increases on condition of radiotherapy, low tumor position and female. When dealing with these patients, preventive measures should be taken into consideration during SPS.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anal Canal , Pathology , General Surgery , Anastomosis, Surgical , Colon , General Surgery , Defecation , Physiology , Factor Analysis, Statistical , Follow-Up Studies , Long Term Adverse Effects , Epidemiology , Radiotherapy , Rectal Neoplasms , Pathology , General Surgery , Rectum , General Surgery , Retrospective Studies , Risk Assessment , Methods , Risk Factors , Sex Factors , Surveys and Questionnaires , SyndromeABSTRACT
Anatomy is the foundation of surgical techniques. With the development of surgery, anatomy also divided into traditional anatomy, surgical anatomy and embryonic development anatomy. Complete mesocolic excision (CME) is one of classic radical operation for colon cancer, based on the modern anatomy. CME advocates correct operation plane, and describes the mobilization and separation of the colon together with the entire regional mesocolon. With the evolution of anatomy, the definition and content of CME-related anatomic landmarks such as mesentery, fascia and space have been changed. This article elaborates theses anatomical structures and their distribution, in order to improve the understanding of colorectal surgeons on CME-related traditional anatomy, surgical anatomy and embryonic developmental anatomy.