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Rectal cancer is one of the common digestive tract malignant tumors in China. In particular, middle and low rectal cancers are the most common. The treatment goal is to preserve anal function as much as possible through tumor radical resection. Owing to anatomical and biological explorations and the widespread application of new surgical equipment, the possibility of anal function-preserving anastomosis in low rectal cancer has gradually increased. This article reviews the research progress on anastomosis for low rectal cancer surgery and discusses its characteristics and operational difficulties.
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In colorectal cancer surgery, loop ileostomy is sometimes necessary to prevent anastomotic leakage. Although ileostomy reversal is relatively simple, postoperative complication is inevitable. In recent years, laparoscopic surgery has been gradually applied in ileostomy reversal due to its small trauma, fast recovery, and low complications, exhibiting satisfactory short-term outcomes. This review analyzes the application of the laparoscopic technique in ileostomy surgery and explores the potential of total laparoscopic surgery, aiming to provide a new perspective for the clinical application of laparoscopic ileostomy reversal.
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Objective:To investigate the expression of glutathione peroxidases 4 (GPX4) in colon adenocarcinoma and its relationship with clinicopathological features and prognosis of patients.Methods:The data set of colon adenocarcinoma was obtained from The Cancer Genome Atlas (TCGA) database to analyze the expression of GPX4 in colon adenocarcinoma tissues and its predictive value for overall survival (OS). A total of 93 colon adenocarcinoma tissues and 87 adjacent mucosa tissues after operation from November 2009 to May 2010 provided by the National Human Genetic Resources Sharing Service Platform were selected. The expression of GPX4 protein was detected by using tissue chip immunohistochemistry. The relations between the expression of GPX4 protein and the clinicopathological features and OS of colon adenocarcinoma patients were analyzed. Cox proportional hazards regression model was used to analyze the factors affecting the prognosis. The nomogram for predicting OS rate was established and drawn.Results:The analysis of data from TCGA database showed that in 380 cases of colon adenocarcinoma, the expression of GPX4 in colon adenocarcinoma tissues were higher than that in the normal colonic mucosa tissues [the value of fragments per kilobase of exon per million fragments mapped (FPKM): 85.654 (20.351-356.237) vs. 56.230 (48.783-63.931)], and the difference was statistically significant ( Z = -6.150, P<0.05). The OS in GPX4 high-expression group (FPKM ≥83.614) were poorer than that in GPX4 low-expression group (FPKM < 83.614) (median OS time: 84.40 months vs. 94.03 months, 5-year OS rate: 58.6% vs. 72.7%), and the difference was statistically significant ( P<0.05). Tissue chip immunohistochemical staining results show that the high-expression rate of GPX4 protein in colon adenocarcinoma tissues was higher than that in adjacent normal tissues [38.0% (35/92) vs. 7.3% (6/82)], and the difference was statistically significant ( χ2 = 22.727, P<0.01); the high-expression rate of GPX4 protein in left colon adenocarcinoma tissues was higher than that in right colon adenocarcinoma tissues [47.2% (25/53) vs. 25.6% (10/39), and the difference was statistically significant ( χ2 = 4.42, P = 0.036); the 5-year OS rate of patients in GPX4 high-expression group was lower than that in GPX4 low-expression group (25.7% vs. 57.9%), and the difference was statistically significant ( χ2 = 9.051, P<0.05). Multivariate Cox proportional hazards regression model analysis showed that lymph node metastasis (stage N 1-N 3) ( HR = 2.241, 95% CI 1.242-4.046, P = 0.007) and high expression of GPX4 ( HR = 2.783, 95% CI 1.598-4.848, P<0.01) were independent factors affecting the poor prognosis of colon adenocarcinoma patients. The above factors were used to establish a nomogram for predicting the prognosis of patients with colon adenocarcinoma, the C index was 0.739, indicating that the nomogram had good predictive performance. Conclusion:The expression of GPX4 is up-regulated in colon adenocarcinoma tissues, and its high expression is related to the malignant biological behavior of the tumor and poor prognosis.
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Cetuximab has become an important molecular targeted drug for the treatment of metastatic colorectal cancer (mCRC), which increases the curative effect of chemotherapy and prolongs the survival time. However, some patients develop insensitiveness or resistance to cetuximab, while the complicated molecular mechanisms are not quite clear. With the deep research in epidermal growth factor receptor (EGFR) signaling pathway, the genetic alteration of KRAS, BRAF, PTEN and PIK3CA and polymorphism of microRNA (miRNA) have been proved to associated with cetuximab resistance. Wnt signaling pathway with its negative regulator RNF43 is also considered to be related with cetuximab resistance in recent studies. The review of the progress on molecular mechanisms of cetuximab resistance in mCRC can establish theoretical basis for finding out reasonable drugs to overcome the resistance.
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Objective@#To evaluate the risk factors of perineal incision complications after abdominal abdominoperineal resection (APR) in elderly patients with rectal cancer.@*Methods@#From January 2007 to September 2018, the clinical data of 72 elderly rectal cancer patients (age≥80 years) underwent abdominoperineal resection at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were collected and retrospectively analyzed. Univariate and multivariate analyses were performed to determine the risk factors of perineal incision complications in elderly patients with rectal cancer after APR.@*Results@#Of the 76 patients, 47 were male and 25 were female, with an average age of (81.8±1.8) years. The incidence of postoperative perineal incision complications was 23.6% (17/72), including 5 cases of wound infection, 4 cases of incision fat liquefaction, and 8 cases of delayed wound healing. All of the patients were well recovered and discharged without death. The result of univariate analysis showed that, the occurrence of perineal incision complications was associated with serum albumin level < 35g/L (χ2=4.860, P=0.027), intraperitoneal chemotherapy with fluorouracil sustained release/lobaplatin rinse (χ2=8.827, P=0.003), pelvic restoration (χ2=9.062, P=0.003), diabetes (χ2=6.387, P=0.011) and coronary heart disease (χ2=7.688, P=0.006). Multivariable logistic regression analysis showed that the intraoperative pelvic restoration (OR=0.17, 95% CI: 0.04~0.82, P=0.027) and diabetes (OR=4.32, 95% CI: 1.05~17.81, P=0.043) were independent risk factors for perineal incision complications.@*Conclusions@#Elderly patients with rectal cancer who undergo APR should preserve and restore the pelvic peritoneum as much as possible. Moreover, perioperative blood glucose monitoring is a powerful guarantee for preventing complications of perineal incision.
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Objective@#This study aims to explore the clinical value of fusion indocyanine green fluorescence imaging (FIGFI) in total laparoscopic radical resection for right colon cancer.@*Methods@#From October, 2018 to December, 2018, 15 patients who underwent total laparoscopic radical resection for right colon cancer using FIGFI in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were retrospectively enrolled in this study. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and complications were collected and analyzed.@*Results@#All patients successfully underwent total laparoscopic radical resection for right colon cancer using FIGFI. 1 patients (6.7%) received extended resection of bowel due to poor blood supply after mesentery excision. The average operation time was 133.7 minutes and intraoperative blood loss was 26.7 ml. The average time to ground activities, fluid diet intake, first flatus and postoperative hospitalization were 19.1 h, 11.7 h, 32.5 h and 5.0 d, respectively. The average length of tumor was 4.5 cm. The average proximal and distal resection margins were 14.9 cm and 12.1 cm, respectively. The average number of lymph nodes retrieved was 29.3 per patient. Only one patient suffered from incisional fat liquefaction after surgery and was managed effectively by regular dressing change. No severe complications such as indocyanine green allergy, anastomotic stenosis, anastomotic leakage, abdominal bleeding, bowel obstruction, pulmonary infection, and abdominal infection occurred in any patients.@*Conclusions@#FIGFI is helpful to judge the blood supply of intestinal segments and anastomotic stoma in total laparoscopic radical resection for right colon cancer quickly. It is a safe and feasible technique with satisfactory short-term effect.
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About 15％-25％ of patients with locally advanced rectal cancer have lateral lymph node metastasis, lymph node metastasis is an important cause of postoperative recurrence and death. Currently, scholars hold different attitudes towards lateral pelvic lymph node dissection (LPLND), because LPLND has many problems such as difficult operation, long operation time and large amount of bleeding. Therefore, there is no optimal treatment strategy for colorectal cancer with enlarged lateral lymph nodes. This article reviews the treatment strategy of lateral lymph node metastasis, the selection factors of LPLND and the safety and feasibility of laparoscopic LPLND.
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Objective To investigate the safety and efficacy of enhanced recovery after surgery (ERAS) used in laparoscopic colorectal cancer surgery.Methods We conducted a retrospective analysis of the medical records of 99 cases treated with ERAS programed laparoscopic colorectal cancer surgery (ERAS group) and 103 cases treated with traditional perioperative care and laparoscopic colorectal cancer surgery (controlled group) from Mar 2017 to Sep 2017 in our center.Results There was no significant difference in age,gender,BMI,ASA classification,tumor location,operation time,pathological stage and the incidence of postoperative complications between ERAS group and controlled group (all P ＞ 0.05).Compared to control group,ERAS had less blood loss,shorter time to pass first flatus,stool and start diet and shorter hospitalization day,with all the difference statistically significant [(60 ± 63)ml vs.(112 ± 245)ml,(3.0±0.8)dvs.(4.3 ±1.2)d,(3.5 ±1.0)dvs.(4.6±1.3)d,(4.1 ±1.2)dvs.(5.4± 2.0)d,(5.8±2.1)dvs.(7.8±2.5)d,t=-2.021、-9.216、-6.887、-5.252、-6.163,allP＜ 0.05].No patients in both groups suffered from readmission or death within 30 days after surgery.Conclusion Patients treated with ERAS programed laparoscopic colorectal cancer surgery is safe and effective,with rapid recovery and reduced hospital stay.
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Objective@#To explore the clinical safety and feasibility of enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma.@*Methods@#From May 1, 2017 to May 1, 2018, 46 patients who underwent laparoscopic-assisted radical resection for rectal carcinoma with enterostomy using running suture of dermis and seromuscular layer in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively enrolled in this study. Data regarding clinicopathologic characteristics, operation and postoperative outcomes, stoma-related complications and functions of stoma were collected and analyzed.@*Results@#All of the 46 patients successfully underwent this operation. Among them, 30 patients underwent laparoscopic-assisted abdominoperineal resection for rectal cancer with sigmoidostomy and 16 patients underwent laparoscopic-assisted low anterior resection for rectal cancer with loop ileostomy. The mean operation time was 115.3 minutes and intraoperative blood loss was 86.1 ml. The mean time for enterostomy was 14.1 minutes. The average time to flatus, time to fluid diet intake and length of hospital stay were 1.8 days, 2.9 days and 6.5 days, respectively. During the follow-up period, three patients suffered from stomal edema, two patients suffered from parastomal hernia, and two patients suffered from skin inflammation surrounding stoma. None of re-operation related stoma and severe mobility such as stomal stenosis, stomal necrosis, stomal prolapse, stomal retraction and stomal mucocutaneous separation occurred. Thirty-five patients recovered with satisfactory stomal function, two with middle function and one with poor function.@*Conclusion@#Enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma is a safe and feasible procedure with a satisfactory short-term effect.
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Objective@#The aim of this study was to explore the clinical safety, feasibility and short-term effect of overlapped delta-shaped anastomosis in total laparoscopic transverse colectomy.@*Methods@#The records, which were based on China National Cancer Center, of 20 and 31 patients who underwent total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis and laparoscopic-assisted transverse colectomy with conventional extracorporeal anastomosis, from March 2017 to May 2018 were reviewed retrospectively. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications were collected and compared.@*Results@#There was no difference between the two groups in overall operation time, anastomosis time and intraoperative blood loss (P>0.05), however, the length of incision was significantly shorter in overlapped delta-shaped group [(4.7±0.6) cm vs. (5.5±1.0) cm, P=0.002]. The time to ground activities, first flatus and postoperative hospitalization did not differ between the two groups (P>0.05). The postoperative visual analogue scale was lower in the overlapped delta-shaped group than the control group on postoperative day 1 (3.7±0.7 vs. 4.2±0.9, P=0.015) and postoperative day 3 (2.7±0.5 vs. 3.2±0.9, P=0.040). The perioperative complication rates were 10.0% and 12.9% in the overlapped delta-shaped group and the control group, respectively, and the difference was not significant (P=0.753).@*Conclusion@#Compared to conventional extracorporeal anastomosis, total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis was a safe and feasible procedure with satisfactory short-term effect, shorter incision and less postoperative pain.
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Objective@#The aim of this study was to explore the clinical safety, feasibility and short-term effect of overlapped delta-shaped anastomosis in total laparoscopic transverse colectomy.@*Methods@#The records, which were based on China National Cancer Center, of 20 and 31 patients who underwent total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis and laparoscopic-assisted transverse colectomy with conventional extracorporeal anastomosis, from March 2017 to May 2018 were reviewed retrospectively. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications were collected and compared.@*Results@#There was no difference between the two groups in overall operation time, anastomosis time and intraoperative blood loss (P>0.05), however, the length of incision was significantly shorter in overlapped delta-shaped group [(4.7±0.6) cm vs. (5.5±1.0) cm, P=0.002]. The time to ground activities, first flatus and postoperative hospitalization did not differ between the two groups (P>0.05). The postoperative visual analogue scale was lower in the overlapped delta-shaped group than the control group on postoperative day 1 (3.7±0.7 vs. 4.2±0.9, P=0.015) and postoperative day 3 (2.7±0.5 vs. 3.2±0.9, P=0.040). The perioperative complication rates were 10.0% and 12.9% in the overlapped delta-shaped group and the control group, respectively, and the difference was not significant (P=0.753).@*Conclusion@#Compared to conventional extracorporeal anastomosis, total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis was a safe and feasible procedure with satisfactory short-term effect, shorter incision and less postoperative pain.
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Objective: To investigate the effect of comorbid cardiovascular diseases on the perioperative period of colorectal cancer pa-tients aged over 80 years. Methods: Clinicopathological data of 313 elderly patients aged over 80 years who underwent radical surgery for colorectal cancer at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from January 2007 to December 2018 were retrospectively collected and analyzed. Propensity score matching was used for 1 : 1 matching of 10 covari-ates. Finally, 128 patients with comorbid cardiovascular diseases were matched with 128 patients without comorbid cardiovascular dis-eases. Perioperative indicators and postoperative complications were compared between the two groups. Result: Both groups were balanced in terms of baseline variables (all P>0.05). In terms of postoperative complications, there was no statistical difference be-tween the two groups [37.5% (48/128) vs . 30.5% (39/128), P=0.235]. According to the Clavien-Dindo classification of postoperative complications, the incidence of postoperative Clavien-DindoⅣcomplications in the comorbid cardiovascular disease group was signifi-cantly higher than that in the non-cardiovascular disease group [7.0% (9/128) vs . 1.6% (2/128), P=0.031]. In terms of local surgical complications, the incidence of postoperative anastomotic leakage in patients with cardiovascular diseases was significantly higher than that in patients without cardiovascular diseases [7.8% (10/128) vs . 2.3% (3/128), P=0.046]. In terms of other local surgical compli-cations, there was no statistical difference between the two groups (all P>0.05). In terms of non-surgical local complications, the inci-dence of postoperative blood circulatory system complications in patients with cardiovascular diseases was significantly higher than that in patients without cardiovascular diseases [10.2% (13/128) vs . 3.1% (4/128), P=0.024]. There was no significant difference in the incidence of other non-surgical local complications between the two groups (all P>0.05). Conclusions: Comorbid cardiovascular diseas-es did not increase the risk of colorectal cancer surgery in patients aged over 80 years. However, it should be noted that the incidence of postoperative blood circulatory system complications and anastomotic leakage is significantly increased in elderly patients with car-diovascular diseases. For such patients, adequate preoperative evaluation, close postoperative monitoring, and the application of pro-tective stoma are key to ensure that elderly patients with colorectal cancer can successfully survive the perioperative period.
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OBJECTIVE@#To explore the safety and feasibility of the overlapped delta-shaped anastomosis (ODA) technique for cases undergoing totally laparoscopic right hemicolectomy (TLRH).@*METHODS@#Clinical data of patients who underwent TLRH using the ODA technique or the modified delta-shaped anastomosis (MDA) technique at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2016 to December 2017 were retrospectively analyzed.@*INCLUSION CRITERIA@#(1)diagnosed with adenocarcinoma by enteroscopy before operation; (2)cancer locating at ascending colon or transverse colon hepatic region and receiving TLRH surgery.@*EXCLUSION CRITERIA@#(1) double or multiple primary colorectal cancers;(2)with complete or incomplete intestinal obstruction; (3) combined multiple organs resection; and (4) with unresectable distant metastases. The ileum and the transverse colon were sutured in an overlapped fashion about 8 cm away from the end of the ileum firstly, and then two small openings locating at the end of ileum and the corresponding site of the transverse colon were created in the ODA procedure, and the two small openings both locating at the end of ileum and the transverse colon were created in the MDA procedure. Statistical analysis was performed using SPSS 24.0 software and the general information, surgical and pathological results, and complications between two groups were compared.@*RESULTS@#A total of 108 patients were enrolled in this study, including 52 patients in the ODA group and 56 patients in the MDA group. In the ODA group, 28 patients were male and 24 were female with age of (53.3±10.0) years and body mass index (BMI) of (24.2±2.7) kg/m. In the MDA group, 27 patients were male and 29 were female with a mean age of (54.5±9.4) years and body mass index of (23.8±2.4) kg/m. There were no significant differences between the two groups in terms of age, gender, BMI, history of previous abdominal surgery, scoring of American Society of Anesthesiologists, tumor location, pathological TNM stage, and number of dissected lymph node (all P>0.05). All the patients underwent R0 resection without conversion to open surgery or to extraperitoneal anastomosis. The time of anastomosis in the ODA group was shorter than that in the MDA group[(15.7±2.3) minutes vs.(18.6±3.6) minutes], and the difference was statistically significant (t=-5.017, P<0.001). There were no significant differences between two groups in total operative time[(160.7±17.8) minutes vs.(163.2±17.6) minutes], intraoperative blood loss [(77.7±28.3) ml vs.(75.9±31.8) ml], length of incision [(5.8±1.1) cm vs. (5.9±1.1) cm], time to first flatus [(1.8±0.2) days vs. (1.9±0.3) days], time to first oral intake [(1.9±0.5) days vs. (1.9±0.4) days], postoperative complications [3.8%(2/52) vs. 5.4%(3/56)], and postoperative hospital stay [(6.7±0.9) days vs. (6.8±0.8) days].@*CONCLUSIONS@#The ODA technique is less time-consuming without increasing postoperative complications compared to the MDA technique, which is a safe and feasible technique in TLRH worth further promotion.
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Female , Humans , Male , Middle Aged , Adenocarcinoma , General Surgery , Anastomosis, Surgical , Colectomy , Methods , Colonic Neoplasms , General Surgery , Laparoscopy , Length of Stay , Postoperative Complications , Retrospective Studies , Treatment OutcomeABSTRACT
Objective@#To discuss the effect and safety of continuous pumping for home enteral nutrition after esophagectomy.@*Methods@#The current study retrospectively analyzed the esophageal cancer patients who underwent transthoracic esophagectomy between January 2017 and November 2017 at First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute. There were totally 108 cases, including 88 males and 20 females, with an average age of 62 years. The patients were divided into pump feeding group (n=56) and traditional tube feeding group (n=52). The postoperative short-term safety, weight maintenance, enteral nutrition tolerance and nutritional support complete rate of the 2 groups were compared by χ2 test, Fisher exact test and t test, respectively.@*Results@#Compared with traditional tube feeding group, the patient safety in pumping feeding group was significantly better, with complications within 2 months after discharge were 11/52 and 4/56 respectively (χ2=2.393, P=0.035); the weight maintenance was significantly better, the weight loss within 4 weeks after discharge were 3.90 kg and 0.13 kg, respectively (t=7.720, P=0.000); the general enteral complications were significantly lower (26/52 vs. 5/56, χ2=22.225, P=0.000), the nutritional support complete rate was significantly higher (23/52 vs. 55/56, χ2=39.167, P=0.000).@*Conclusions@#Continuous pump feeding enteral nutrition support after discharge postoperatively could help improve patient safety after discharge, which is better for weight maintenance of the patients. Pump feeding could also enhance tolerability of tube feeding and ensure the effective accomplishment of nutritional support.
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Objective@#The aim of this study was to explore the clinical safety and feasibility of intracorporeal delta-shaped anastomosis in total laparoscopic left hemicolectomy.@*Methods@#From January 1, 2017 to October 1, 2017, 11 patients who were diagnosed with left colon cancer and underwent total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis were retrospectively enrolled in this study. Clinicopathologic characteristics, surgical and postoperative outcomes were collected and analyzed.@*Results@#The median operation time was 121.8 minutes and the median time for anastomosis was 14.9 minutes. The median intraoperative blood loss was 45.5 ml. The lengths of the upper and lower segments of resection from colon cancer were 11.4 cm and 8.5 cm, respectively. The median number of lymph nodes retrieved was 29.5. The median time to ground activities, time to flatus, time to fluid diet intake and length of hospital stay were 1.4 days, 3.0 days, 3.8 days and 6.9 days, respectively. Only one patient suffered from incision infection during his hospitalization due to preoperative long-term smoking history. No mobility related to the anastomosis such as anastomotic bleeding, stenosis, obstruction and leakage occurred in any patients.@*Conclusion@#Total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis is a safe and feasible procedure with a satisfactory short-term effect.
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Objective@#To study the feasibility, safety and short-term efficacy of total laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection.@*Methods@#From May 2014 to March 2016, 17 patients with rectal carcinoma were treated by total laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection. The clinical data of these patients was collected and retrospectively analyzed to assess the impact of the operation on postoperative recovery time and the incidence of complications.@*Results@#All operations had been successfully accomplished without conversion to open surgery or conversional laparoscopic-assisted surgery . The median operative time was 105 minutes. The median blood loss was 35 ml. The median proximal and distal margin of tumor is 16 cm and 3.5 cm. The median number of lymph nodes harvest is 21, and the median first bowl movement is 43 hours. The hospitalization after operation is 8 days. No patient underwent abdomen hemorrhage or anastomotic leakage.@*Conclusion@#Laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection appears to be feasible, safe and with promising efficacy for selected patients.
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BACKGROUND@#Currently, there is no consensus on the follow-up strategy (follow-up time interval and content) of non-small cell lung cancer (NSCLC) in the world, and the relevant clinical evidence is also very limited. In this study, we aimed to summarize the recurrence/metastasis sites and timings of stage I NSCLC patients based on their follow-up data, aiming to provide a basis of follow-up time interval and content for this group of patients.@*METHODS@#We retrospectively analyzed the 416 stage I NSCLC patients that underwent continuous anatomic lobectomy between Jan. 2000 to Oct. 2013 in our prospective lung cancer database. According to the recurrence/metastasis sites and timings, the long term follow-up time interval and content were explored.@*RESULTS@#The 5-yr disease free survival (DFS) and overall survival (OS) in the whole group were 82.4% and 85.4%, respectively. There were 76 cases (18.3%) had recurrence/metastasis during follow-up, among which the most frequent site was pulmonary metastasis (21 cases, 5.0%), followed by brain metastasis (20 cases, 4.8%), bone metastasis (12 cases, 2.9%), and mediastinal lymph node metastasis (12 cases, 2.9%). Among the factors that could influence recurrence/metastasis, patients with pT2a suffered from a higher recurrence/metastasis rate compared to patients with pT1 (P=0.006), with 5-yr DFS being 73.8% and 87.3%, respectively (P=0.002), and the 5-yr OS being 77.7% and 90.3%, respectively (P=0.011).@*CONCLUSIONS@#The commonest recurrence/metastasis sites of stage I NSCLC after anatomic lobectomy are lung, brain and mediastinal lymph nodes, the risk of recurrence/metastasis within 2 years were equal to that between 3 years and 5 years. The follow-up frequencies and content within 2 years could be adjusted according to T stages.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Carcinoma, Non-Small-Cell Lung , Mortality , Pathology , General Surgery , Follow-Up Studies , Lung Neoplasms , Mortality , Pathology , General Surgery , Lymph Nodes , General Surgery , Lymphatic Metastasis , Neoplasm Staging , Pneumonectomy , Prospective Studies , Retrospective StudiesABSTRACT
BACKGROUND@#Thoracoscopic surgery has gradually become the major procedure for lung cancer surgery in our department. Its characteristics are minimal trauma and quick recovery, which make approximately 90% of patients discharge from the hospital after surgery. However, the postoperative complications still happen now and then. We analyzed the patients who had been hospitalized for longer than 7 days after thoracoscopic lung cancer surgery, aiming to summarize the types and risk factors of complications, and improve postoperative safety of patients.@*METHODS@#The data were come from the prospective database of Thoracic Surgery Unit One in Peking Cancer Hospital, and patients that underwent thoracoscopic pulmonary surgery between Jan. 2010 and Dec. 2014 with length of stay more than 7 days were included in the study. The classifications of the complications were investigated and graded as mild or severe complications according to modified Claviengrading, the relationship between clinical factors and degrees of complications was also analyzed.@*RESULTS@#The hospitalization of 115 cases were longer than 7 days after surgery, accounting for 10.3% (115/1,112) of the whole patients that underwent surgery during the same period. Eighty-one cases had mild complications, accounting for 7.3% (81/1,112) of the whole cases that underwent surgery during the same period and 70.4% (81/115) of the cases with prolonged length of stay; the proportions of severe complications in both groups were 3.1% (34/1,112) and 29.6% (34/115), respectively; and the proportions of complications that caused perioperative deaths were 0.18% (2/1112) and 1.7% (2/115), respectively. Among all the postoperative complications, the most common was air leakage for more than 5 days after surgery, with a total of 20 cases (1.8% and 17.4%). The other common complications were: atelectasis (19 cases, 1.7% and 16.5%), pulmonary infection (18 cases, 1.6% and 15.7%), etc. The less common complications was bronchopleural fistula (4 cases, 0.36% and 3.5%) with very high risk, and 2 cases died perioperatively due to the combination of acute respiratory distresssyndrome (ARDS). In the clinical factors, only preoperative low pulmonary function (FEV1%<70%) was the potential risk factor for postoperative severe complications (45.8% vs 23.6%, P=0.038). There was no significant difference either regarding the 5 year disease free survival or the 5 year overall survival between mild complication group and severe complication group, with 5 year DFS being 52.2% and 51.9%, respectively (P=0.894) , and 5 year overall survival being 64.0% and 53.5%, respectively (P=0.673).@*CONCLUSIONS@#Continuous postoperative air leakage, atelectasis and pulmonary infections were the major causes for prolonged hospitalization after thoracoscopic surgery for lung cancer, and bronchopleural fistula was the most perilous complications. Patients with low preoperative pulmonary function were more likely to have severe postoperative complication, however, this would not influence the long term survival of the patients.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Hospitalization , Length of Stay , Lung Neoplasms , General Surgery , Therapeutics , Postoperative Complications , Epidemiology , Postoperative Period , Prospective Studies , Thoracic Surgery, Video-AssistedABSTRACT
Objective@#To evaluate the prognosis factors affecting perineal incision complications after abdominoperineal resection (APR) for the low rectal cancer.@*Methods@#This was a retrospective analysis of 151 consecutive patients with low rectal cancer undergoing APR between January and December 2013 at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The patients were comprised of 95 males and 56 females. The mean age of the patients was (57.3±10.9) years (ranging from 31 to 79 years). χ2 test and Logistic regression analysis were used to identify the prognosis factors of perineum incision complications.@*Results@#In all 151 patients, perineal incision complications were confirmed in 31 patients (20.5%), including 8 cases of incision infection, 22 cases of poor healing of perineal wound, and 1 case of incision fistula formation. In univariate analysis, the factors associated with perineal incision complications were American Society of Anesthesiologists grade (χ2=7.116, P=0.008), intraoperative blood loss (χ2=9.157, P=0.002), while the protective factors associate with perineal incision complications were the intraperitoneal chemotherapy with fluorouracil sustained release (χ2=5.020, P=0.025), pelvic restoration (χ2=10.158, P=0.001), operation experience (χ2=7.334, P=0.007). The gender, age, body mass index, diabetes, preoperative radiochemtherapy, hemoglobin level, albumin level, distance from distal tumor to anal verge, the procedure of APR, operating time, intraoperative blood transfusion, total drainage volume 3 days after operation, tumor differentiation and the postoperative TNM staging were not associated with perineal incision complications (P>0.05). Multivariable logistic regression analysis showed that the intraoperative pelvic restoration (OR=0.200, 95% CI: 0.045 to 0.894, P=0.035) and intraoperative blood loss (OR=2.953, 95% CI: 1.155 to 7.551, P=0.024) were independent prognosis factors of perineum incision complications.@*Conclusions@#For patients with low rectal cancer undergoing APR procedure, pelvic restoration wound be needed. The operation should be performed by experienced doctors, intraoperative blood loss should be reduced when possible.
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<p><b>OBJECTIVE</b>To explore the surgical treatment patterns and clinicopathological prognostic factors of anorectal malignant melanoma (ARMM).</p><p><b>METHODS</b>The medical records and follow-up data of 64 patients with anorectal malignant melanoma undergoing surgical treatment from August 1972 to December 2015 were collected and analyzed retrospectively. Distant metastasis was discovered in 4 patients when diagnosis, of whom 3 underwent abdominoperineal resection(APR), the other underwent wide local excision (WLE). In the other 60 cases, 46 underwent ARP(1 case received additional right inguinal lymph node dissection), the other 14 underwent WLE(1 case received additional right inguinal lymph node dissection).</p><p><b>RESULTS</b>The median follow-up time of 64 cases was 24(4 to 139) months. The 1-year, 3-year and 5-year overall survival rate was 70.3%, 35.3% and 18.4%, respectively. The 5-year survival rate of 60 patients without distant metastasis undergoing APR and WLE was 19.7% and 23.1%, and the median survival was 19.6 and 24.3 months, respectively(P =0.634), which was not significantly different. According to the Kaplan-Meier method for univariate analysis, involved margins (P=0.024), lymph metastasis (P=0.018) and clinical staging(P=0.003) had significant effects on overall survival. Multivariate analysis indicated that only the lymph node metastasis was significant predictive factor (RR=16.614, 95%CI:1.165 to 236.847, P=0.038).</p><p><b>CONCLUSIONS</b>The prognosis of ARMM is poor. The lymph node metastasis is the main predictive factors. Operation procedure (APR or WLE) has no obvious effect on prognosis.</p>