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Object:To explore surgical treatments for duodenal fistula with intra-abdominal infection.Methods:The data of 19 patients with duodenal fistula treated at the Affiliated Tumor Hospital of Zhenzhou University between Jan 2015 and Dec 2021 were analyzed retrospectively. Surgery is performed with duodenostomy or modified duodenal shunt procedures.Result:All patients were accompanied by intra-abdominal infection, including 9 duodenal stump fistulas. All patients successfully completed the operation,11cases underwent duodenostomy, 8 case underwent modified duodenal shunt procedures. operating time was 110(60-140)min, postoperative hospitalization time was 29(9-103)d. Two patients died postoperatively. Fistula heals in other patients.Conclusion:Surgical intervention for duodenal fistula should focus on controlling the source of infection, strengthening intestinal and abdominal drainage, and reducing postoperative complications.
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Objective:To evaluate the strategy and skills of reoperation for recurrent carcinoma at the stoma of esophagojejunostomy after total gastrectomy.Methods:The management experience in 18 patients at the Department of General Surgery, Tumor Hospital of Zhengzhou University from Oct 2016 to Jul 2021 were analyzed retrospectively.Results:Thirteen patients underwent left thoracoabdominal combined incision to completely remove the tumor.One patient developed anastomotic leakage, two patients developed pulmonary infection, one patient developed costochondritis, all were cured and discharged after conservative treatment; Nine patients had no postoperative complications. Two patients abandoned surgery due to high position of the tumor, 3 patients due to poor cardiopulmonary function, and were given radiotherapy and chemotherapy.The postoperative follow-up period was 4.6 to 42.9 months. Four patients died of tumor recurrence, and the remaining patients survived until the end of the follow-up. The overall 1-and 3-year recurrence-free survival rates were 100% and 20%, respectively.Conclusion:Surgery on recurrent carcinoma at esophagojejunostomy stoma after total gastrectomy, although difficult and challenging,could still benefit most patients when at the hands of expertise.
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Objective:To explore the prognostic value of combined fibrinogen/albumin ratio (FAR) and CA724 in patients with stage Ⅱ/Ⅲ gastric cancer after radical resection.Methods:A total of 932 patients were enrolled in the study, and the best cut-off values of CEA, FAR, NLR and other variables were obtained through ROC curve analysis. According to the FAR-CA724 score, patients were divided into 3 groups: FAR-CA724=0 (CA724<3.43 ng/ml and FAR<0.083), FAR-CA724=1 (CA724≥3.43 ng/ml and FAR≥0.083) and FAR-CA724=2 (CEA≥3.43 ng/ml and FAR≥0.083).Results:After FAR-CA724 grouping, the patient's age (χ 2=12.02, P=0.002), gender (χ 2=15.91, P<0.001), tumor size (χ 2=18.22, P<0.001), hypertension (χ 2=6.35, P=0.042), tumor location (χ 2=26.09, P<0.001), degree of differentiation (χ 2=12.46, P=0.002) and pTNM staging (χ 2=6.68, P=0.035) are significantly different. Survival analysis showed that there were significant differences in OS between the three groups of patients (FAR-CA724=0, 1, and 2: 88.2%, 64.3% and 37.8%, respectively, P<0.001). By multivariate analysis FAR-CA724 is an independent risk factor affecting OS in patients with stage Ⅱ/Ⅲ gastric cancer after radical surgery. Conclusions:Preoperative FAR-CA724 may be a potential blood marker for predicting the prognosis of GC patients.
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Objective:To evaluate a nano-carbon lymphatic tracing method for patients with rectal cancer after neoadjuvant radiotherapy and chemotherapy .Method:Retrospective analysis was made on 88 patients of rectal cancer undergoing neoadjuvant chemoradiation at the Department of General Surgery, He′nan Cancer Hospital from Jan 2016 to May 2020.According to whether nano-carbon lymph node was used or not, patients were divided into nanocarbon tracer group (study group) and non-nanocarbon tracer group (control group).Results:There was statistically significant in the number of havested lymph nodes between the two groups [15(11-19) vs.9(5-12), Z=5.227, P<0.001], There was no statistically significant in the number of positive lymph nodes between the two groups [0(0-0.25) vs.0(0-1), Z=1.199, P=0.231]. There were significant differences in the ratio of patients with less than 7 lymph nodes(0/34 vs.18/54, χ 2=14.248, P<0.001) and patients with less than 10 lymph nodes (4/34 vs.29/54, χ 2=15.657, P<0.001). Conclusions:The injection of nanocarbon after neoadjuvant chemoradiotherapy can increase the number of harvested postoperative lymph nodes and the ratio of patients with lymph nodes ≥7 and ≥10, which is more beneficial for prediction of the prognosis of patients.
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Objective:To investigate the effects of preoperative endoscopic mucosal injection of carbon nanoparticle tracer and intraoperative serosa injection of carbon nanoparticle tracer on the acquisition of lymph nodes in total gastrectomy for gastric cancer.Methods:The retrospective cohort study was conducted. The clinical data of 118 patients with gastric cancer who underwent total gastrectomy in the Affiliated Tumor Hospital of Zhengzhou University between May 2017 and April 2018 were collected. There were 79 males and 39 females, aged from 26 to 81 years, with an average age of 59 years. Of 118 patients, 56 patients undergoing preoperative endoscopic mucosal injection of carbon nanoparticle tracer were divided into observation group and 62 patients undergoing intraoperative serosa injection of carbon nanoparticle tracer were divided into control group. Observation indicators: the total number of lymph node dissected, the number of positive lymph node dissected, the number of lymph node dissected at the first station and the number of lymph node dissected at the second station. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent-sample t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the rank sum test. Results:The total number of lymph node dissected, the number of positive lymph node dissected, the number of lymph node dissected at the first station, the number of lymph node dissected at the second station of the observation group were 48±16, 3(range, 0-25), 26±9, 23±7, respectively. The above indicators of the control group were 41±13, 4(range, 0-28), 25±8, 16±5, respectively. There were significant differences in the total number of lymph node dissected and the number of lymph node dissected at the second station between the two groups ( t=2.494, 6.588, P<0.05), and there was no significant difference in the number of positive lymph node dissected and the number of lymph node dissected at the first station between the two groups ( Z=0.747, t=1.689, P>0.05). Conclusions:Carbon nanoparticle labeled lymph node staining using preoperative endoscopic mucosal injection of carbon nanoparticle tracer or intraoperative serosa injection of carbon nanoparticle tracer is safe and effective in total gastrectomy for gastric cancer. Compared with intraoperative serosa injection of carbon nanoparticle tracer, preoperative endoscopic mucosal injection of carbon nanoparticle tracer can increase the total number of lymph node dissected, especially the number of lymph node dissected at the second station of gastric cancer.
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Objective@#To assess the clinical value of neutrophil-to-lymphocyte ratio (NLR) in predicting anastomotic leak of postoperative rectal cancer patients.@*Methods@#The clinical data of 787 rectal cancer patients who underwent anterior resection from January 2014 to December 2017 in Affiliated Tumor Hospital of Zhengzhou University were collected. The postoperative numbers of white blood cell (WBS) on postoperative day (POD)1, 3 and 5 were detected, and the NLR was calculated. The relationship of NLR and the incidence of anastomotic leak was analyzed, and the area under the receiver-operating characteristic (ROC) curves was calculated. The accuracy of postoperative NLR in predicting the incidence of anastomotic leak was evaluated.@*Results@#WBC counts of patients with leak on POD1, POD3 and POD5 were 13.2×109/L, 9.1×109/L and 8.9×109/L, respectively, while those of patients without leak were 12.9×109/L, 9.0×109/L and 8.8×109/L. The WBC count was not significantly different between patients with or without leak (P>0.05). The average NLR values of patients with or without leak were 13.3 and 11.6 on POD1, 10.9 and 7.6 on POD3, 9.3 and 5.3 on POD5, respectively. The NLR values of patients with leak on POD3 and POD5 were significantly higher than those of patients without leak (P<0.05). The cutoff value of NLR on POD3 was 8.6, the sensitivity and specificity of detecting the leakage was 73.2% and 75.6%, respectively, and the area under curve (AUC) was 0.744. The cutoff value of NLR on POD5 was 5.5, the sensitivity and specificity was 69.6% and 75.5%, the AUC was 0.726. The multivariate analysis result showed that NLR >8.6 was an independent factor for anastomotic leak prediction.@*Conclusion@#Postoperative NLR on day 3 is useful in predicting anastomotic leak and can decrease the incidence of complication in rectal cancer patients who underwent anterior resection.
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Objective:To investigate the expression of annexin A9(ANXA9)in gastric cancer tissues and cells and its effect on the proliferation of gastric cancer cells and the ability of subcutaneous tumorigenesis in nude mice.Methods:Immunohistochemistry and qPCR were used to detect the relationship between the expression of ANXA9 and clinicopathological parameters and prognosis in gastric cancer and paired adjacent tissues.Lentivirus transfection was used to inhibit the expression of ANXA9 in gastric cancer cell line SGC-7901. Cell counting kit-8 (CCK-8) and clone formation were used to detect the changes of proliferation of SGC7901, flow cytometry to detect the changes of SGC-7901 cell cycle, and nude mouse model bearing subcutaneous gastric cancer xenograft was established using SGC-7901 cells with stable ANXA9 knockdown to assess the effect of low expression of ANXA9 on xenograft growth.Results:Immunohistochemistry showed that the expression level of ANXA 9 was 67.1% and 30.7% in gastric cancer tissues and adjacent tissues, respectively. qPCR showed that the expression levels of ANXA 9 mRNA in gastric cancer tissues and adjacent tissues were 0.142±0.107 and 0.819±0.191, respectively. The difference was statistically significant ( P<0.05). The high expression of ANXA9 was different from the low expression group in the degree of tissue differentiation ( P<0.05), and the median survival time was 50 and 59 months, respectively. OD values of the transfected cells were 0.285±0.025, 0.386±0.031, 0.711±0.032, 1.007±0.084, 1.552±0.055 and 0.274±0.026, 0.380±0.049, 0.714±0.035, 1.106±0.081, 1.561±0.060, respectively, compared with 0.294±0.011, 0.445±0.046, 1.076±0.096, 1.588±0.095, 2.286±0.110 in NC group ( P<0.05). Cell clone formation in the transfection group was 207±12 and 225±14, lower than that in the NC group (412±14, P<0.05). After inhibiting the expression of ANXA9, the proportion of G 0/G 1 phase cells in the transfection group was 62.80% and 55.87%, respectively, significantly increased compared with 44.37% in the NC group. The proportions of S-phase cells in the transfected group were 22.74% and 21.44%, respectively, which were significantly lower than that in the NC group 29.19% ( P<0.05), after stable interference with ANXA9, the growth rate of transplanted tumors was significantly slower than that of the control group. On the 23rd day, the average volume of transplanted tumors in the two groups were (625±49) mm 3 and (303±157) mm 3, respectively, and the mass of tumor tissues in the two groups were (1.60±0.11) and (0.57±0.09) g ( P<0.05). Conclusions:Down-regulation of ANXA9 expression can inhibit the proliferation of gastric cancer cells and the ability of subcutaneous tumor formation in nude mice.
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Objective:To evaluate a new nano-carbon lymphatic tracing method to increase the number of lymph nodes acquired in patients with neoadjuvant chemotherapy for gastric cancer.Method:From Jan 2015 to Mar 2016, 159 patients with gastric cancer were recruited including 66 cases in study group receiving nano carbon injection under the mucosa layer one day before the operation, and 93 cases with intraoperative subserosal layer injection as control.Results:The average number of lymph nodes obtained in the study group was 47.0±14.7, while that in control was 38.0±14.5, P<0.05. The number of fibrotic lymph nodes obtained in the study group was 3.1 ± 1.9, compared with 3.0±1.8 in control, P>0.05. The number of black-stained lymph nodes in the former was 22.3±4.4, and the later was 14.7±4.8, P<0.05. The lymph nodes harvested in the first station in study group was 26.6±8.5, while that in the control group was 24.1±9.9, P>0.05. The lymph nodes obtained in the second station was 20.4±6.9 in study group, while in control was 13.8±5.7, P<0.05. Conclusions:The submucosal injection of nanocarbon one day before surgery increase the number of lymph nodes obtained in gastric cancer patients with neoadjuvant chemotherapy.
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Objective To explore the safety and efficacy of middle line approach identified with superior mesenteric vein in the right hemicolectomy combined with pancreaticoduodenectomy for colonic carcinoma involing liver and duodenun.Methods Clinical data of 13 patient's with right colonic cancer (T4b) undergoing right hemicolectomy combined with pancreaticoduodenectomy from Jan 2016 to Jul 2019 in He'nan Provincial Tumor Hospital were retrospectively analyzed.The superior mesenteric vein was used to mark the medial border of tumor resection.Vertical cutline was made to transverse mesocolon and all the way done to the root of superior mesenteric vein,the pancreas was cut in front of superior mesenteric vein,superior mesenteric artery and the affiliated lymph nodes were dissected.The stomach and pancreas were transected,the specimen was removed.Then the GI tract was reconstructed.Results Surgery was successful in all 13 patients.The operation time was (249 ± 27) min,blood loss was (442 ± 129) ml,2 cases suffered pancreatic fistula,there was no biliary fistula,and 1 case of delayed gastric emptying.There were no other major complications.The number of lymph node dissection was (20 ± 4) and hospital stay was (23.2-± 9.4) d.Conclusions It is safe and feasible to use the superior mesenteric vein-identified middle line approach in patients of right colonic cancer undergoing right hemicolectomy plus pancreaticoduodenectomy.
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Objective@#To evaluate surgical repair of vesicorectovaginal fistula using transvaginal pedicled omentum pull-through combined transanal colon pull-through.@*Methods@#A total of 11 patients with postoperative vesicorectovaginal fistulas complicating female reproductive system malignant tumors undergoing repairement from Aug 2013 to Aug 2018 were retrospectively analyzed. In order to isolate, protect the bladder and eliminate residual vaginal cavity using transvaginal pedicled omentum pull-through, combined transanal colon pull-through to repair vesicorectovaginal fistula.@*Results@#All the 11 patients in this group completed the operation successfully, and no air or stool passing from the vaginal after the operation. The fistula disappeared in five patients confirmed by cystography and enterograph. The average operation time was 115 min, the average blood loss was 260 ml.Incision fat liquefaction was found in two. Incision infection occurred in one. Urinary dysfunction in two. Anal stenosis was found in four patients which were healed by anal dilation.@*Conclusions@#Transvaginal pedicled omentum pull-through combined transanal colon pull-through can eliminate vesicorectovaginal fistula, improve life quality and avoid colostomy.
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Objective To evaluate surgical repair of vesicorectovaginal fistula using transvaginal pedicled omentum pull-through combined transanal colon pull-through.Methods A total of 11 patients with postoperative vesicorectovaginal fistulas complicating female reproductive system malignant tumors undergoing repairement from Aug 2013 to Aug 2018 were retrospectively analyzed.In order to isolate,protect the bladder and eliminate residual vaginal cavity using transvaginal pedicled omentum pull-through,combined transanal colon pull-through to repair vesicorectovaginal fistula.Results All the 11 patients in this group completed the operation successfully,and no air or stool passing from the vaginal after the operation.The fistula disappeared in five patients confirmed by cystography and enterograph.The average operation time was 115 min,the average blood loss was 260 ml.Incision fat liquefaction was found in two.Incision infection occurred in one.Urinary dysfunction in two.Anal stenosis was found in four patients which were healed by anal dilation.Conclusions Transvaginal pedicled omentum pull-through combined transanal colon pull-through can eliminate vesicorectovaginal fistula,improve life quality and avoid colostomy.
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Objective To investigate the effect of the first surgical treatment on progression-free survival (PFS)time of retroperitoneal liposarcoma and the prognosis.Methods We analyzed the clinical data of 74 cases of retroperitoneal liposarcoma from 1998 to 2016 in He'nan Cancer Hospital (Zhengzhou University Affiliated Tumor Hospital Department of General Surgery).Results The results demonstrated that progression-free survival time of the first surgical resection of retroperitoneal liposarcoma in patients related with tumor necrosis (P ＜ 0.001),lobulated tumor (P ＜ 0.001),symptoms (P =0.013),Ro resection (P =0.003),distant metastasis (P =0.028),postoperative chemotherapy (P =0.006) and tumor differentiation (P ＜ 0.001).Progression-free survival time was not correlated with gender,age of first diagnosis,the invasion of adjacent organs,tumor size,operation time and combined organ resection (all P＞0.05).The rate of 1-year,3-year,5-year survival time attached to PFS≤24 m and PFS ＞24 m were 93.7％ vs.94.7,90.5％ vs.80.9％,58.4％ vs.74.8％(P=0.111).Conclusion The first attempt of radical resection determines progression-free survival of retroperitoneal liposarcoma,however,patients' PFS was not related with their overall survival.
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Objective@#To establish a scoring system to predict the risk of anastomotic leakage in patients with rectal cancer older than 60 years.@*Methods@#The study included 995 patients (≥ 60 years) with rectal cancer locating 3-12 cm from the anal verge who underwent anterior resection or intersphincteric resection at the Department of General Surgery, Henan Cancer Hospital from January 2012 to December 2016. Potential risk factors for leakage were subjected to univariate analysis. Multivariate logistic regression analysis was used to identify the independent risk factors for anastomotic leakage. The scoring system was developed based on regression coefficient for each significant risk factor. One point was allocated to the risk factor with a regression coefficient β < 1, and two points were allocated to the risk factor with β > 1. The proposed scoring system was tested by the area under curve (AUC) of the receiver operating characteristic curve (ROC) .@*Results@#Surgery was successfully performed in all 995 patients. The incidence of anastomotic fistula was 4.6% (46/995) . Among these 46 patients, 31 recovered after conventional treatment, and 13 patients underwent transverse colostomy, and 2 died of multiple organ failure. Independent risk factors included age (β = 0.643, OR = 1.902, 95%CI: 1.020 - 3.614, P = 0.048) , body mass index (BMI) (β = 1.218, OR = 3.379, 95%CI: 1.607 - 7.105, P = 0.001) , albumin levels (β = 0.986, OR = 2.681, 95%CI: 1.432-5.021, P = 0.002) , and level of anastomosis from the anal verge (β = 1.395, OR = 4.034, 95%CI: 2.086-7.801, P = 0.000) . The scoring system was created base on coefficient β of the independent risk factors (age≥70 years for 1, BMI≥25 kg/m2 for 2, albumin levels < 35 g/L for 1, level of anastomosis from anal verge < 4.0 cm for 2) . All the scores were added up, and all patients were divided into the high-risk group (4-6 points, n=71) and intermediate-low-risk group (0-3 points, n=924) based on the scoring system. The incidence of anastomotic leakage in the two groups was 23.9% (17/71) and 3.1% (29/924) , respectively (χ2 = 60.092, P = 0.000) . The AUC of age, BMI, albumin levels, and level of anastomosis from the anal verge were 0.598, 0.591, 0.622, and 0.635 respectively. The AUC of the scoring system was 0.656, which was higher than above parameters with a sensitivety of 0.37 and specificity of 0.94.@*Conclusions@#The scoring system is effective and accurate for identifying a subgroup at high risk for postoperative anastomotic leakage in rectal cancer patients over 60 years old.
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Objective To explore the clinical effects of pedicled ligamentum teres hepatis in preventing duodenum stump fistula after resection of gastric cancer.Methods The clinicopathological data of 563 patients with gastic cancer who underwent resection from Jan.2013 to Dec.2016 were analyzed.Results Fourteen patients in the control group developed duodenum stump fistula.Four patients in the experimental group developed duodenum stump fistula.The incidence of duodenum stump fistula in the control group was 4.6％,while that in the experimental group was 1.5％ (x2 =4.356,P =0.037).All the 14 patients in the control group had high fever and 2 died of multiple organ failure,8 were cured with conservative treatment,and 4 received reoperation.For patients in the experimental group,moderate fever was observed in 2 patients and all were cured by conservative treatment.Conclusion Pedicled ligamentum teres hepatis was safe and effective to prevent duodenum stump fistula after resection of gastric cancer.
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Objective To explore the clinical application value of carbon nanoparticles labeled lymph node staining combined with artery approach in radical resection of sigmoid colon cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 40 patients with sigmoid colon cancer who were admitted to the Tumor Hospital of Zhengzhou University (Henan Cancer Hospital) from December 2015 to June 2016 were collected.Among 40 patients undergoing radical resection of sigmoid colon cancer,20 using nanometer carbon lymph node staining combined with artery approach and 20 using the traditional lymph node sorting were respectively allocated into the observation group and control group.Observation indicators:(1) detection of the lymph node and pathological examination;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect adjuvant chemotherapy,tumor recurrence or metastasis and surgery-related complications up to June,2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were evaluated with the t test.Comparisons of count data were analyzed using the chi-square test.The comparisons of ordinal data were analyzed using the nonparametric test.Results (1) Detection of the lymph node and pathological examination:40 patients underwent successful radical resection of sigmoid colon cancer.The lymph node sorting time,total and average numbers of lymph node sorting,total and average numbers of lymph node with diameter ＜ 5 mm,cases with lymph node number ＜ 12 and numbers of the first,second and third stations lymph nodes were respectively (13.1±2.4) minutes,522,28.0±7.0,152,8.6±2.5,0,13.7±3.6,9.5±2.5,4.7±1.2 in the observation group and (18.4±3.5) minutes,239,13.0±3.0,64,3.9± 1.7,6,6.1 ± 1.6,6.6± 2.2,2.5± 1.0 in the control group,with statistically significant differences between groups (t =14.562,24.872,19.256,x2 =4.902,t =14.368,10.026,8.210,P＜0.05).The total number of positive lymph node,positive rate of lymph node,metastasis rate of patients,total and average numbers of positive lymph node with diameter ＜ 5 mm and numbers of the first,second and third stations positive lymph nodes were respectively 82,0.22％±0.13％,17/20,51,3.9± 1.9,4.2± 1.8,1.9±0.6,2.3± 1.2 in the observation group and 43,0.48％±0.18％,7/20,38,2.7±1.5,2.1±0.6,2.6±0.7,1.4±0.5 in the control group,showing no statistically significant difference in the positive rate of lymph node and number of the third station positive lymph nodes between groups (t =1.462,1.759,P＞0.05).There were statistically significant differences in the metastasis rate of patients,average number of positive lymph nodes with diameter ＜ 5 mm and numbers of the first and second stations positive lymph nodes between groups (x2 =10.417,t =7.264,4.682,3.410,P＜0.05).(2) Follow-up situations:40 patients were followed up for 12-18 months,with a median time of 16 months.Eighteen and 10 patients in the observation group and control group received postoperative adjuvant chemotherapy,showing a statistically significant difference between groups (x2=5.833,P＜ 0.05).Tumor recurrence or metastasis was respectively detected in 0 and 2 patients (1 with local recurrence and 1 with liver metastasis) in the observation group and control group,with no statistically significant difference between groups (x2=2.105,P＞ 0.05).During the follow-up,there was no surgery-related complication.Conclusion The carbon nanoparticles labeled lymph node staining combined with artery approach in radical resection of sigmoid colon cancer can increase the sorting rate and number of lymph node,and improve the accuracy of postoperative pathological staging.
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Objective To investigate the application value of the curved cutter stapler device combined with trans-orally inserted anvil (OrVil) in the radical resection of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 206 patients with Siewert type Ⅱ AEG who were admitted to the Henan Tumor Hospital between March 2011 and March 2016 were collected.All the 206 patients underwent radical resection and 3-step clock wise total gastrectomy + D2 lymph node dissection.Observation indicators:(1) surgery and postoperative recovery situations:surgical approach,overall operation time,hammer anvil placing time,esophagojejunal anastomosis time,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,postoperative complications and duration of postoperative hospital stay;(2) postoperative pathological examination and chemotherapy;(3) follow-up and survival situations.Follow-up using telephone interview and outpatient examination was performed to detect tumor-free survival of patients up to April 2016.Measurement data with normal distribution were represented as x±s.The survival rate was calculated by the Kaplan-Meier method.Results (1) Surgery and postoperative recovery situations:all the 206 patients received successful operations,including 85 with abdominal operation,50 with abdominal incision through the diaphragmatic muscle into thoracic surgery and 71 with thoracic-abdominal surgery.Overall operation time,hammer anvil placing time,esophagojejunal anastomosis time,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation and duration of hospital stay were (113.7± 15.4)minutes,(3.5± 1.2)minutes,(10.4±2.9)minutes,(128±25) mL,32± 6,(2.4 ± 0.9) days and (12.3 ± 1.9) days,respectively.Of 206 patients,15 with postoperative complications were cured by conservative treatment,including 6 with implicit anastomotic fistula,3 with dominant anastomotic fistula,2 with pancreatic leakage,2 with intestinal obstruction,1 with anastomotic stenosis and 1 with thoracic and abdominal infection.There was no reoperation due to perioperative complications.(2) Postoperative pathological examination and chemotherapy:postoperative pathological results showed that distance from resection margin of the esophagus to tumor was (5.2±0.4) cm,without cancer cells in the resection margin.Among 206 patients,171 received postoperative chemotherapy by S1 single agent combined with oxaliplatin for 6-8 cycles or oral S1 single agent for 1 year.(3) Follow-up and survival situations:206 patients were followed up for (2.7± 0.3)years,with a tumor-free 3-year survival rate of 58％.During the follow-up,there was no recurrent anastomotic tumor.Conclusion The curved cutter stapler device combined with OrVil in the radical resection of Siewert type Ⅱ AEG can simplify the difficulty of esophagojejunal anastomosis and guarantee the safe resection margin of the lower esophagus.
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Objective To evaluate a novel lymph node (LN) sorting method on surgical resected sample guided by nanometer carbon staining and principle following the supplying artery tributory in rightsided colon carcinoma.Methods From May 2015 to June 2016,51 patients were randomly divided into two groups adopting traditional LN sorting method and that of a combination of nanometer carbon and artery guided.The final LN status were compared between the 2 groups.Results The total LN number and the positive LN in novel method group were higher than control group (437 vs.349,70 vs.54).The dissection time used,the number of harvested positive LN that was ＜ 5 mm were significantly different [(13.1 ± 3.2) minvs.(17.8 ±3.8)min,t=4.75,P=0.000;1.0±l.0vs.0.2 ±0.6,t=3.51,P=0.000].The number of patients with harvested LN less than 12,the rate of positive lymph nodes,the rate of metastasis were not significantly different (all P ＞ 0.05) between the two groups.Conclusions Use of nanometer carbon development combined with artery approach facilitates LN sorting,yielding more positive LNs,and increating the accuracy of pathological staging in right-sided colon cancer.
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Objective To explore the clinical effects of pedicled omentum in preventing anastomotic leakage after resection of colorcctal cancer complicated with intestinal obstruction.Methods The clinicopathologic data and anastomotic leakage rate of 102 patients with colorectal cancer undergoing resection from Dec.2012 to Dec.2015 were analyzed.Results Seven patients in the control group developed anastomotic leakage.Only 1 patient in the experimental group developed anastomotic leakage.The incidence of anastomotic leakage in the control group was 12％,while that in the experimental group was 2％ (x2 =4.250,P =0.039).Of the 7 patients complicating anastomotic leakage in control group,1 died of multiple organ failure,1 was cured with conservative treatment,and 5 were done with diverting stoma.The one leakage in experimental group was cured by conservative treatment.Conclusion Pedicled omentum is useful in the prevention of anastomotic leakage after resection of colorectal cancer in settings of intestinal obstruction.
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Objective To evaluate the result of early repair for urinary fistula caused by iatrogenic injury to ureter,bladder and urethra during resection of rectal cancer.Methods We retrospectively analyzed 26 cases of urinary fistula after resection of rectal cancer patients encountered in Department of General Surgery,Henan Tumor Hospital from October 2005 to May 2016.Urinary fistula was divided into four types according to the site of fistula.Results Surgery was performed ever after the diagnosis of the fistula was identified.In type Ⅰ fistula (6 cases of posterior urethral fistula) the treatment was stent placement and packing of the greater omentum.2 cases of bladder top fistula (type Ⅱ),were treated by fistula repair and cystostomy.Type Ⅲ involved 12 cases (bladder triangle fistula).The treatment was ureter stenting replantation,and cystostomy Type Ⅳ:ureteral fistula in 6 cases,the treatment was end-to-end anastomosis and stenting.After surgery 24 cases were cured and 2 cases (all of type Ⅲ fistula) ended up with permanent bilateral ureterocutaneostomy.Conclusion It is safe and effective to make early remedy repair for ureter,bladder and urethral fistula iatrogenically during rectal cancer resection.
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Objective To explore the risk factors of ulcerative colitis-associated colorectal cancer (UC-CRC).Methods The retrospective case-control study was conducted.The clinicopathological data of 536 patients with ulcerative colitis (UC) who were admitted to the Henan Tumor Hospital from March 2004 to June 2015 were collected.Observation indicators:(1) follow-up results:cases with follow-up,follow-up time,cases of UC-CRC,age of onset,pathological type of UC-CRC;(2) risk factors analysis affecting occurrence of UC-CRC:gender,age of onset,course of disease,severity of disease,disease classification,extent of lesion,smoking history,family history of colorectal cancer,anemia,hypoproteinemia,body weight loss,extraintestinal manifestations,colonic polyps,backwash ileitis,atypical hyperplasia,anxiety or depression,treatment method and regular endoscopy reexamination.Follow-up using outpatient examination and telephone interview was performed to detect prognosis of patients up to April 2017.Patients underwent colonoscopy once every 6 months within 3 years after diagnosis and once every 1 year after 3 years.Measurement data with skewed distribution were described as M (range).The univariate analysis was done using the chi-square test and Fisher exact probability.The multivariate analysis was done using the Logistic regression model.Results (1) Follow-up results:of 536 patients,450 were followed up for 26.0-120.0 months,with a median time of 76.4 months.During the follow-up,16 patients were complicated with UC-CRC,including 9 males and 7 females.Age of onset of colorectal cancer was 14-78 years,with an average age of onset of 44 years.Pathological type:high-differentiated right colon adenocarcinoma was detected in 5 patients,high-and moderate-differentiated left colon adenocarcinoma in 3 patients,left colon signetring cell carcinoma in 2 patients,moderate-differentiated rectal tubular adenocarcinoma in 3 patients,highdifferentiated rectal papillary adenocarcinoma in 2 patients and malignant lymphoma in 1 patient.(2) Risk factors analysis affecting occurrence of UC-CRC:the results of univariate analysis showed that course of disease,extent of lesion,colonic polyps and atypical hyperplasia were risk factors affecting occurrence of UC-CRC (x2 =14.848,18.885,10.554,P＜0.05).The results of multivariate analysis showed that course of disease ＞ 10 years,lesion involving the whole colon,colonic polyps and atypical hyperplasia were independent risk factors affecting occurrence of UC-CRC (OR=12.893,17.847,7.326,19.742,95％ confidence interval:1.726-74.337,1.445-89.793,1.263-43.128,3.625-96.524,P＜0.05).Conclusion The course of disease ＞ 10 years,lesion involving the whole colon,atypical hyperplasia and colonic polyps are independent risk factors affecting occurrence of UC-CRC.