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Objective To compare the clinical effect of proximal gastric malignant tumor treated by the total gastrectomy and the proximal gastrectomy.Methods 278 patients with gastric cancer were randomly divided into two groups by double blind method(1 ∶ 1).Patients in the two groups received total gastrectomy (TG)and proximal gastrectomy(PG) treatment,respectively.The surgery effect,postoperative complications,survival rate and tumor recurrence rate were compared between the two groups.Results In PG group,the average blood loss was (151.6 ± 26.4)mL,operation time was (124.5 ±36.2) min,hospital stay was(8.9 ± 3.1) days,which were significantly lower than those in TG group (231.5 ± 15.3) mL,(162.4 ± 24.8) min and (12.6 ± 6.2) days (t =45.352,36.521,11.243,all P ＜0.05).The lymph node excision rate of PG group was (13.2 ± 3.1)％,which was significantly lower than (16.4 ±4.6) ％ in TG group(t =9.654,P ＜ 0.05).The incidence rate of postoperative complications between the two groups had statistically significant difference(x2 =25.321,20.254,all P ＜ 0.05).The survival rates of 3 years,5 years in TG group were 62.16％,42.32％,those in PG group were 60.39％,34.23％.The 3 years survival rate had no significant difference between the two groups (x2 =6.321,P =0.079),5 years survival rate had statistically significant difference between the two groups (x2 =31.265,P =0.000).The recurrence rate in group TG was 22.30％,which was significantly lower than 34.53 ％ in PG group (x2 =29.365,P =0.000).Conclusion Average blood loss,operation time,hospitalization time and postoperative complications of PG group are less,,but the lymph node resection rate is low,tumor recurrence rate is high,the 5-year survival rate is lower than the TG after surgery.TG can be recommended for the proximal gastric malignancy.
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Objective To explore the technique and effect of selected three-field lymphadenectomy by left thoracotomy in treatment of thoracic middle or lower section esophageal squamous carcinoma. Methods From Jun. 2005 to Mar. 2009, 213 patients with thoracic middle or lower section of esophageal carcinoma received esophagectomy, bilateral mediastinal lymphadenectomy and pleural membrane resection.Group 1 -5, 7 - 12a, 16al, and 19 were performed to dissect abdominal lymph node and extended thoracic and abdominal lymphadenectomy and only lymph node extraction of mesoesophagus in neck field. Results 14197 lymphatic nodes(LN) were detected in 213 case. The average number of resected LN was 66. 65 ±24. 73. The metastatic lymph node was detected in 105 cases. The metastatic rate was 49.05% (105/213).There were 423 metastatic lymph nodes. The lymph nodes metastasis was 2. 97% (423/14197) of all dissected lymphatic nodes. No remnant carcinoma in the upper and lower cutting edge was found in pathological examination. The operation time ranged from 2. 92 ～ 4. 67 ( 3. 37 ± 0. 42) hours. Blood transfusion during perioperative period was 0 ～ 6u ( 1.08 ± 0. 93 ) u. Perioperative plasma transfusion was 0 ～ 1400( 103.77 ± 184. 89) ml. The hospital-time was 14 ～ 39 ( 17.64 ±4. 12) days. There were no anastomotic leakage and recurrent laryngeal nerve injury. One case died from respiratory failure, the mortality was 0. 04% ( 1/213). Conclusion Surgical approach in the management of left thoracotomy in the sixth intercostals could extend resection of chest-field lymph node dissection, decrease neck field lymph node dissection. Abdomen-field lymph node dissection reached selected D3. The selected lymphadenectomy procedure had the advantages of small traumas and few complications.
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Objective To investigate the relationship between apoptcsis, expressions of VEGF and clinicopathological characteris- tics, and prognosis in esophageal squamous cell carcinoma (ESCC). Methods Sixty-one surgical specimens of primary esophageal squa- mous cell carcinomas were examined for VEGF by immunohistochemical staining (S-P). Apoptcsis was determined by TUNEL (TdT media- ting dUTP-biotin nick end-labeling) method. Clinicopathologic features were examined by histopathology. The prognostic impacts of these pa- rameters were analyzed by univariate and survival analysis. Results AI and VEGF were well correlated with differentiation, TNM stage. Lower tumor differentiation and higher TNM stage were related to decreasing AI and VEGF. In addition, VEGF in the groups of invasion be- yond muscularis and lymph node metastasis is significant higher than that in invasion reaching muacularis and no lymph node metastasis (P <0.01). But there were no significant correlation between AI and invasion( P>0.05). The simple-factor analysis results showed that the decrease of AI, VEGF, lymph node metastases, lower tumor differentiation, and invasion reaching muscularis were related to decrease of sur- vival rate. However, multivariate Cox analysis demonstrated that only AI and VEGF were the significant prognostic factors. Conclusions Apoptosis and angiagenesis participate in ESCC and promote its growth. VEGF is related to angiogenesis of ESCC. The increase of VEGF may promote invasion and lymph node metastasis. AI and VEGF are significant prognostic factors in ESCC.