Medial approach versus lateral approach in laparoscopic colorectal resection: a meta-analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the safety and efficacy of the medial approach(MA) and the lateral approach (LA) in the treatment of colorectal disease.</p><p><b>METHODS</b>Studies published from January 1994 to April 2013 that compared MA to LA in laparoscopic colorectal resection were collected. Publications in English were mainly identified from Medline, Embase, Cochrane Library, and those in Chinese from Wanfang database and CNKI database. Conversion rate, operative time, blood loss, number of harvested lymph nodes, hospital stay, complication, mortality, recurrence, and hospitalization costs of MA and LA were meta-analyzed using fixed-effect and random-effect models.</p><p><b>RESULTS</b>Five cohort studies (2 randomized controlled trials and 3 retrospective studies) including 881 patients were enrolled and analyzed. Of these patients, 416 and 465 underwent laparoscopic colorectal resection with MA and LA respectively. As compared to LA, MA had significantly lower conversion rate (OR=0.42, 95%CI:0.25-0.72, P=0.001), shorter operative time (WMD=-52.62, 95%CI:-63.23--42.01, P<0.01), less number of harvested lymph nodes (WMD=-1.17, 95%CI:-1.89--0.45, P=0.001), while blood loss was less and hospitalization cost lower. Significant differences in intraoperative complications and postoperative complications were not found between the two group (OR:0.57, 95%CI:0.15-2.18, P=0.41; OR:0.78, 95%CI:0.52-1.17, P=0.23).</p><p><b>CONCLUSIONS</b>Compared with LA, MA has the advantages of shorter operative time and lower conversion rate with similar safety. Differences in blood loss, hospitalization cost and oncological safety between the two approaches warrant further investigation.</p>

Meta-analysis of proximal gastrectomy and total gastrectomy for cancer of cardia and fundus / 中南大学学报(医学版)

OBJECTIVE@#To assess the value of proximal gastrectomy (PG) and total gastrectomy (TG) for the treatment of cancer of cardia and fundus.@*METHODS@#Publications on comparision between PG and TG in the treatment of cancer of cardia and fundus were collected, the data from the publications were matched with the PG group and the TG group respectively according to its corresponding surgical resection, and the data on postoperative complications, motality and 5-year survival rate were meta-analyzed by fixed effect model and random effect model.@*RESULTS@#Thirteen reseaches on 2 219 patients were included in this study, 2 of which were randomly controlled studies. There were no significant differences in the postoperative complications (OR=1.00, 95%CI: 0.44-2.28,P>0.05) and mortality (OR=1.25, 95%CI: 0.62-2.48,P>0.05) between the PG group and the TG group, while there was significant difference in the 5-year survival rate (HR=0.87, 95%CI: 0.76-0.99,P=0.04). The 5-year survival rate in the TG group was higher than that in the PG group.@*CONCLUSION@#Total gastrectomy for the treatment of cancer of cardia and fundus has better long-term therapetic effect.

The Diagnosis and Treatment of 18 Cases of Rectal Gastrointestinal Stromal Tumors / 中国肿瘤临床

Objective: To assess the clinical features, diagnosis and treatment of gastrointestinal stromal tumor in the rectum.Methods: Records of 18 patients diagnosed as GIST in the rectum between January 2002 and April 2009 were re-viewed and the major clinical features, treatment modalities and outcomes were analyzed.Results: The clinical features of GIST in the rectum were nonspecific.Most patients manifested with bloody stool or changes in bowel habits.CT scan or MRI findings showed necrosis and/or hemorrhage in the tumor and well defined tumor margins.Even in the case of large GIST, no lymphadenopathy was not found, which could be a factor for the differential diagnosis of GIST from other rectal neoplasms.All of the resected tumor specimens showed positive expression of CD117 and CD34 in immunohistochemical staining.Low and very low risk patients accounted for 44.4% (8/18).All patients received surgery.Twelve patients were treated with local excision with different approaches.Anterior resection of the rectum (Dixon) was undertaken in three pa-tients and abdominoperineal resection (Miles) in three patients.Neoadjuvant therapy with imatinib was applied for three pa-tients with partial response.After a median follow-up of 34 months (1～84 months), recurrence and/or metastasis occurred in five patients, and three of them were treated with imatinib.One patient received Miles surgery after repeated local exci-sions.Only one patient died of bone metastasis.Recurrence-free survival (RFS) of the local excision group was longer than that of abdominoperineal resection (APR) group (75.0±8.4 months vs 26.0±11.1 months, P=0.023).Conclusion: The treatment for rectal GIST should be individualized and be different from that of rectal cancer.Treatment decision and choice of procedures should be based on careful preoperative evaluation of tumor size, location, extent and risk level.Most of the anorectal GIST were rated as low-risk in this cohort and could be excised locally by different approaches with satisfactory outcome.Neoadjuvant therapy with imatinib may benefit some patients to obtain the opportunity of sphincter-saving.

Clinicopathologic characteristics, diagnosis, and treatment of 30 patients with hereditary nonpolyposis colorectal cancer / 中南大学学报(医学版)

OBJECTIVE@#To explore the clinicopathologic and molecular characteristics of hereditary nonpolyposis colorectal cancer (HNPCC), and to improve the level of diagnosis and treatments of HNPCC.@*METHODS@#Thirty HNPCC patients (HNPCC group) who were treated in Xiangya Hospital were retrospectively analyzed, and 25 patients with sporadic colorectal cancer in the same duration were randomly chosen as a control group. The onset of age, location of tumor, pathological type, treatment method, and prognosis were compared in the 2 groups. The expression loss rate of mismatch repair gene (MMR) MLH1 and MSH2 in the 2 groups was detected by immunohistochemistry.@*RESULTS@#The onset age in the HNPCC group was earlier than that in the control group (P0.05).@*CONCLUSION@#HNPCC patients are characterized with early onset associating with multiple tumors. The accuracy of diagnosis can be improved by combining the detection of MMR gene. Optimal surgical treatment and close follow-up may bring good result to HNPCC patients.

Digestive tract reconstruction after total gastrectomy for gastric cancer / 中国普通外科杂志

Objective To study the optimal procedure of digestive tract reconstruction after total gastrectomy.Methods The clinical data of 122 patients who underwent total gastrectomy in the recent 6 years were(analyzed) retrospectively.Three types of reconstruction procedures,including Orr-type Roux-en-Y(esophagojejunostomy),P-type jejunal pouch Roux-en-Y esophagojejunostomy and distal jejunal aboral pouch Roux-en-Y esophagojejunostomy,were performed.Results There were no significant differences among the three procedures in heartburn and the amount of food intake,frequencies of meal,weight loss,dumping(syndrome),and hemoglobin and albumin levels.The operation time in P-type group was longer than the other two group(P

Prevention of postoperative abdominal adhesions with sandostatin in rats / 中国普通外科杂志

Objective　To assess the efficacy of sandostatin in preventing postoperative adhesions in rats. Methods　Fifty SD rats were randomly divided into five groups: Group 1, Control group; group 2, sandostatin 20μg/kg intraperitoneal injection (IP); group 3, sandostastin 40μg/kg IP; group 4, sandostatin 60μg/kg IP; group 5, hyaluronate sodium(HA) IP. All animal were killed on the 14th postoperative day. After adhesions were graded according to their severity, adhesive ileal segments were resected for hydroxyproline(OHP) determination. Results　The severity of adhesions in group 2.3.4 and 5 were significantly milder than that in group 1.(P<0.05). The OHP levels of adhensive intestine in group 2.3 and 4 were significantly lower than that in group 1 and 5 (P<0.05).The severity of adhesions and OHP levels in group 2.3 and 4 had no significant difference (P>0.05). Conclusions　Intraperitoneal administration of sandostatin intraoperatively might have some efficacy in preventing adhensions of intestine.

Further improve the result of treatment for colorectal cancer / 中国普通外科杂志

Objective To pay attention to further improving the result of treatment for colorectal cancer (CRC). Methods On the basis of reviewing the current literature, in view of the present situation of the surgical care for CRC patients the issues of improving the treatment of CRC were appraised. Results There is a great discrepancy in the results of surgical treatment for CRC from different hospitals and among different surgeons in terms of the rates of curative resection, operative mortality and morbidity, local recurrence, anastomotic leakage and overall survival. Surgical technique and the knowledge as well as the experience of the surgeons may have an impact on the outcome. Adjuvant chemotherapy and radiation therapy have contributed to the increase of resectability and survival reate and decrease of the recurrence rate after surgery. The availability of new cytostatic agents and other drugs may improve the resectability of liver metastases and prolong the survival in advanced disease. Conclusions Strengthening the specialty training of surgical personals and emphasizing the application of standard adjuvant therapy are the key points for further improving the result of treatment for CRC and other malignancies.

Surgical treatment of familial adenomatous polyposis / 中国普通外科杂志

Objective To study the clinical characteristic and the surgical treatment of the patients with familial adenomatous polyposis(FAP). Methods Retrospective analysis was made on the clinical feature and operative procedures of 28 patients with FAP in our hospital in recent 14 years. Of the 28 patients, 20 patients had familial history, 6 had cancerization. Results All the patients received operation, ileal pouch- anal anastomosis(IPAA) were performed on 25 cases(89.29%) , 3 cases underwent other operations. No severe complications had taken place postoperatively. All the patients received non-steroid anti-inflammatory drugs(NSAIDs) or tamoxifen treatment. All the patients were followed-up for 2-14 years, 4 patients died(14.29%) during follow-up period. Life quality and bowel function after operation were good in the aliving patients. No polyp in ileum pouch was seen. Conclusions Surgical treatment is the main methods for FAP, it can prevent bowel polyp carceration. Use of NSAIDs or tamoxifen as an adjuvant treatment of FAP is useful in the prevention of FAP recurrence.