Laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction: A meta-analysis / 解放军医学杂志

Objective To systematically evaluate the efficacy and safety of laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction.Methods The databases including PubMed,EMbase,The Cochrane Library (Issue 3,2017),ICTRP,CNKI,VIP,CBM and Wanfang Data were electronically searched to collect randomized controlled trials (RCTs) about laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction patients from inception to March 2017.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Then meta-analysis was conducted by RevMan 5.3 software.Results A total of 31 studies involving 3293 patients were included.The results of meta-analysis showed that,compared with the open surgery group,the laparoscopic adhesiolysis group could significantly reduce the recurrence rate (OR=0.18,95％CI 0.12-0.25,P＜0.000 01),overall complications (OR=0.17,95％CI 0.13-0.23,P＜0.000 01),wound infection (OR=0.21,95％CI 0.13-0.35,P＜0.000 01),pneumonia (OR=0.35,95％CI 0.15-0.82,P=0.02) and intestinal fistula (OR=0.32,95％CI 0.15-0.70,P=0.005).Conclusions Current evidence shows that laparoscopic adhesiolysis can reduce the recurrence rate and complications in adhesive small bowel obstruction.Due to the limited quality of included studies,more high quality studies are needed to verify the above conclusion.

Diagnosis and management of metastatic pancreatic tumors / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the clinicopathological features and prognostic factors of metastatic pancreatic tumor.</p><p><b>METHODS</b>The clinical data of 18 metastatic pancreatic tumors were retrospectively analyzed. The primary foci of these 18 patients included: 8 lung cancer, 2 gastric cancer, and malignant histiocytoma, melanoma, rectal cancer, thyroid cancer, renal cell carcinoma, esophageal carcinoma, liver cancer and ovarian cancer each.</p><p><b>RESULTS</b>All these 18 patients harboring metastatic pancreatic tumor did not show any specific symptoms but were frequently found to have a solitary (14 cases) or multiple (4 cases) homogeneous and hypodense nodules on CT scan without any enhancement except one metastatic renal cell carcinoma. The diagnosis was cytologically confirmed in 14 patients by fine needle aspiration biopsy guided by CT or ultrasonography, and diagnosed by postoperative pathology in the other 4 patients. After receiving combined modality treatment, their survival time was 8 to 38 months with an average of 19 months.</p><p><b>CONCLUSION</b>Metastatic pancreatic tumors are rare and give no specific symptom or image finding. Selection of appropriate combined modality treatment according to the type of primary focus is very important for the management.</p>

Clinicopathological characteristics and prognosis of remnant stomach cancer--report of 45 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics and prognostic factors of remnant stomach cancer.</p><p><b>METHODS</b>The clinicopathological and prognosis data of 45 patients with remnant stomach cancer were retrospectively analyzed.</p><p><b>RESULTS</b>The remnant stomach cancer are likely to develop in males with a ratio of male to female: 44:1. Their initial operation modes of these patients were Billroth II subtotal gastrectomy in 40 patients, Billroth I subtotal gastrectomy in 4 and proximal subtotal gastrectomy in 1. The interval from the initial operation to the diagnosis of remnant stomach cancer was 5 to 42 years with an average of 23 years. Of these 45 patients, 28 had lesion at anastomotic site, 9 in the gastric cardia and 8 in other locations; 19 had radical resection, 16 palliative resection and 10 exploration alone except one who had an anastomosis of remnant stomach with the jejunum. The histology types included: 1 un-differentiated adenocarcinoma, 36 poorly-differentiated adenocarcinoma, 7 moderately-differentiated adenocarcinoma and 1 well-differentiated adenocarcinoma. The 1-, 3-, 5-year survival rates of patients with radical resection were significantly better than those treated with palliative resection, which was 100% vs. 62.5%, 78.8% vs. 25%, 47.2% vs. 0, respectively (P < 0.05). All ten patients without resection died within 2 years with an average survival time of 12 months. The 5-year survival rate of stage I, II, III and IV was 100%, 75%, 17.8% and 0, respectively (P < 0.05).</p><p><b>CONCLUSION</b>Remnant stomach cancer prevalently occurs in the male usually 10 years after Birroth II gastrectomy. The lesions is mainly located at anastomotic site. Poorly-differentiated adenocarcinoma is found to be the prevalent histological type of advanced remnant stomach cancer. The prognosis of remnant stomach cancer is correlated with pTNM stage and whether having been treated with complete resection or not. Patients with early remnant stomach cancer may survive for a long time if radical resection can be done.</p>