ABSTRACT
Objective To compare the clinical efficacy of the distal pancreatectomy with spleen preservation and the splenectomy in pancreatic tail for the treatment of benign and borderline tumor. Methods A total of 37 patients with pancreatic benign and borderline tumor from January 2012 to De-cember 2014 in our hospital were treated by laparoscopic surgery.Eleven cases were received distal pan-createctomy with spleen preservation(spleen preserving group)and 26 cases were received resection of pancreatic tail with spleen containing(splenectomy group).Results The operation time of spleen preser-ving group and splenectomy group were(165.34 ± 12.25)mins and(170.72 ± 14.37)mins(P>0.05). The blood loss in the preserving spleen group(108.52 ± 13.11)ml was significantly less than that in the splenectomy group(186.25 ± 17.43)ml(P <0.05).The hospitalization time of the preserving spleen group(10.16 ± 2.11)d was significantly shorter than that of the splenectomy group(12.78 ± 2.78)d(P<0.05).The use of Octreotide in the preserving spleen group(11.45 ± 3.75)mg was significantly less than that in the splenectomy group(16.75 ± 5.75)mg(P <0.01).All patients were followed up for three years.The disease free survival(DFS)in the spleen preserving group was higher than that in the splenecto-my group(100% vs.88.46%)with P<0.05.Conclusion The distal pancreatectomy with spleen preser-vation is safe,effective and suitable for pancreatic benign and borderline tumors.
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Objective:To evaluate the efficacy and safety of cytoreductive surgery (CRS) in conjunction with hyperthermic intra-peritoneal chemotherapy (HIPEC) for treating patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC). Methods:A total of 62 CRC patients with complication of PC were divided into the CRS group, namely, Group One (n=29, CRS and systemic adju-vant chemotherapy) and the CRS+HIPEC group, namely, Group Two (n=33, CRS+HIPEC). The primary end point of the study was overall survival (OS) and the secondary end point was serious adverse events (SAE). Results:Patients' clinicopathologic characteris-tics, peritoneal carcinomatosis index, and completeness of cytoreduction therapy were well balanced and comparable between the two groups. The median follow-up was 41.9 mo (6.5 mo to 110.0 mo) in Group One and 32.0 mo (10.5 mo to 95.9 mo) in Group Two. The median OS was 8.5 mo (95%CI:4.9 mo to 12.1 mo) in Group One and 14.5 mo (95%CI:11.9 mo to 17.1 mo) in Group Two (P=0.007). Within 30 days after the surgery, SAE occurred in 3 of the 29 patients in Group One, and 9 of the 33 patients in Group Two (P=0.126). Multivariate analysis revealed that HIPEC, CC0-1 score, and chemotherapy over six cycles were the independent factors for OS improvement. Conclusion:The CRS+HIPEC method improves the OS of patients with PC from CRC, suggesting an acceptable safety.
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Objective To study the effect of endoscopic treatment for acute appendicitis (AA)without perforation or gangrene.Methods A total of 94 patients with AA were randomly divided into operation group (n =45 ) to receive appendectomy,control group (n =15 ) to accept conventional medicine of metronidazole and Cefoxitin and colonoscopy group (n =34) to undergo conventional medicine plus endoscopic treatment.The time for alleviation of abdominal pain,duration and mean cost of the hospitalization,and the recurrence rate in one year were compared.Results Compared to operation group,colonoscopy group was superior in the duration [ (2.77 ± 0.27) d vs.(6.65 ± 1.68) d ] and mean cost of hospitalization [ ( 1011.35 ± 22.12) yuan vs.(4023.37 ± 32.02 ) yuan ] ( P ＜ 0.05 and P ＜ 0.01,respectively).There were no significant differences in the time for alleviation of abdominal pain or the recurrence rate in one year between 2 groups.Colonoscopy group was superior to control group in all the indices (P ＜ 0.05 ).Conclusion Endoscopic treatment for AA without perforation and gangrene is effective and safe,which can be considered as the first-line treatment.
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Objective To evaluate the impact of mesoreetal margin micrometastasis on local recurrence of rectal carcinoma after total mesorectal excision, and the relation between mesorectal margin mierometastasis and local recurrence. Methods Mesorectal margin specimens from 52 cases of rectal cancer after total mesorectal excision were studied by reverse transcriptase-polymerse chain reaction (RT-PCR) to detect the expression of CK20 mRNA. These patients were divided into CK20 mRNA positive and negative group and followed up for 3 years until local recurrence developed. Results In 52 patients with rectal cancer,21 cases were found to express CK20 mRNA in mesorectal margin, the expression rate of CK20 mRNA in Dukes A,B and C was 17% ,30% and 54% (P<0.05), respectively. The positive rate of well differentiated, moderately differentiated, poorly differentiated and undifferentiated carcinomas were 43%, 38% ,40% and 50% ,respectively(P>0.05 ). The incidence of local recurrence in CK20 mRNA positive and negative group was 24% and 3% , respectively. The difference was statistically significant between the two groups (P <0.05 ). Conclusion Detection of mesorectal margin CK20 mRNA as micrometastasis by RT-PCR in rectal carcinoma patients was a sensitive and effective way in predicting local recurrence. It is necessary for patients with positive mesorectal margin CK20 mRNA to undergo postoperative radiotherapy after total mesorectal excision.