Safety and efficacy of hand-assisted laparoscopic versus open distal gastrectomy for gastric cancer: A systematic review and meta-analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To systematically assess the safety and efficacy of hand-assisted laparoscopic distal gastrectomy (HALG) versus open distal gastrectomy (ODG) for gastric cancer.</p><p><b>METHODS</b>Chinese or English literature regarding comparison of HALG and ODG were collected by searching in databases (such as PubMed, Cochrane Library, CNKI, Wanfang database) between January 1996 and September 2016. The data of operative time, incision length, blood loss, number of harvested lymph nodes, time to flatus, hospital stay, postoperative complication morbidity and long-term outcomes were compared between the two procedures. Then funnel plot was used to evaluate publication bias and sensitivity analysis was used to evaluate the stability of the results. All these data analyses were performed using the Meta for or Meta package of R version 3.3.1.</p><p><b>RESULTS</b>A total of 7 studies with 835 patients (323 cases in HALG group and 512 cases in ODG group) were included. Compared with ODG, HALG had a longer operative time (WMD=28.93 minutes, 95%CI=9.59 to 48.28, Z=2.93, P=0.000), a shorter incision length (WMD=-10.31 cm, 95%CI=-14.01 to -6.62, Z=-5.47, P=0.000), less blood loss (WMD=-140.08 ml, 95%CI=-215.07 to -65.09, Z=-3.66, P=0.000), faster gastrointestinal recovery (WMD=-1.23 days, 95%CI=-1.89 to -0.56, Z=-3.62, P=0.000), shorter postoperative hospital stay (WMD=-3.24 days, 95%CI=-5.47 to -1.02, Z=-2.85, P=0.000). In subgroup analysis, 3 studies published before 2013 vs. 4 studies published afterwards, the number of harvested lymph nodes (WMD=-0.78, 95%CI=-2.05 to 0.50, Z=-1.19, P=0.235) and postoperative complication morbidity (RR=1.02, 95%CI=0.43 to 2.44, Z=0.05, P=0.961) did not differ significantly between two groups. Compared with ODG, the RR(95%CI) of ileus of HALG was 0.43 (0.07 to 2.82), but the difference was not statistically significant (P=0.383). One study reported the 5-year overall survival rates of HALG and ODG were 81.0% vs 67.5%, and the tumor recurrence rates were 7.1% vs 22%, respectively, but the differences were not statistically significant(all P>0.05). Sensitivity analysis showed that the above results were stable. The funnel plots of the lymph nodes and postoperative complication morbidity did not present significant publication bias.</p><p><b>CONCLUSIONS</b>HALG has the advantages of minimal invasiveness such as shorter incision length and quicker recovery. Furthermore, the short-term efficacy of HALG is similar to conventional open surgery. However, the long-term efficacy is lack of support from multicenter long-term follow-up results.</p>

Efficacy comparison of lymph node dissection patterns of the reverse and the cabbage in hand-assisted laparoscopic D2 radical gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the clinical efficacy of the lymph node dissection patterns of the reverse and the traditional cabbage in hand-assisted laparoscopic D2 radical gastrectomy (HALG).</p><p><b>METHODS</b>From December 2010 to October 2013, 194 patients with HALG in Chengdu Military General Hospital were enrolled in this study. According to the pattern of lymph node dissection, 108 patients were performed with the reverse procedure which took spleen as starting point, from left to right, and 86 patients were performed with the traditional cabbage procedure which took the abdominal cavity as the center, from both sides to middle. A retrospective comparative analysis was made on the intra- and post-operative data between the two groups.</p><p><b>RESULTS</b>All the patients were successfully performed with HALG, and no peri-operative death occurred. There were no significant differences in the incision length [(7.0 ± 0.2) cm vs. (6.9 ± 0.3) cm], the operative time [(170.9 ± 33.8) minute vs. (174.6 ± 22.4) minute], dissected lymph node number (17.6 ± 7.5 vs. 17.1 ± 5.8) and post-operative complications [(6.5%(7/108) vs. 8.1%(7/86)] between the reverse group and cabbage group (all P>0.05). However, less blood loss [(204.6 ± 98.2) ml vs. (259.1 ± 122.6) ml, P<0.01] and shorter postoperative hospital stay [(9.0 ± 1.7) day vs. (10.5 ± 4.0) day, P<0.01] were observed in reverse group as compared to cabbage group. During 1 to 6 months follow-up, no death case was found in reverse group, while 1 case died due to upper gastrointestinal bleeding 48 days after operation in cabbage group.</p><p><b>CONCLUSION</b>Efficacy is similar between the two HALG procedures in lymph node dissection, while reverse procedure has certain advantages, such as less blood loss and faster recovery.</p>

Study on Dynamic Expression of Hepatic Proliferating Cell Nuclear Antigen in The Occurrence and Development of Hepatocellular Carcinoma / 中国普外基础与临床杂志

Objective To study the expression of proliferating cell nuclear antigen (PCNA) in the occurrence and development of hepatocellular carcinoma. Methods Sixty SD rats were randomly divided into control group and experimental group. 3′-Me-DAB was administrated into rats to establish the experimental model of hepatocarcinoma. The expressions of PCNA of different phases were detected by immunohistochemistry and the liver pathologic changes were observed by optical microscope. Results The process of canceration was divided into three stages: inflammation, proliferative fibrosis and hepatic carcinoma. The expression of PCNA firstly presented in the oval cells that located in the portal area at the stage of inflammation, and a part of PCNA were hyper-expressed in the portal area. The expression rate of PCNA in the middle phase of inflammatory stage was higher than that of any other phases but declined later. Yet, when it came to the stage of hepatic carcinoma, the rate increased again. Conclusion Under the experimental circumstance when liver cancer is caused by the carcinogenic agent, PCNA may be firstly expressed in the oval cells, and the dynamic expression of PCNA may be an indicator for the early diagnosis of hepatocarcinogenesis.

Experimental Research of Distribution and Migration of Oval Cells in Progressive Hepatic Injury / 中国普外基础与临床杂志

Objective To explore the distribution and migration of oval cells in progressive hepatic injury.Methods Sixty SD rats were divided into the control group ( n =20) and experimental group ( n =40). After the establishment of hepatic carcinoma models, C kit was continuously detected by immunohistochemistry and the liver pathologic changes were regularly observed by optical microscopy. Results The hepatic surface was smooth with eumorphism in histology in the control group. The C kit positive cells were occasionally found. In the experimental group, the oval cells with C kit positive were initially discovered in the portal regions in the second week, and these cells proliferated along the bile duct epithelia. With the hepatic injury becoming more serious, the oval cells extended into the hepatic lobular regions from the portal regions. When hepatocellular carcinoma occurred,the majority were mixed carcinomas, and the oval cells were found inside and outside the carcinoma nodes. In this period, the most of C kit positive cells still located in the portal regions. Conclusion ①The oval cells are the most sensitive cells for the hepatic injury. ②The oval cells which migrate unruly participate in the formation of hepatic pseudolobules. ③The oval cells play an important role in hepatocarcinogenesis.

The evaluation of endoprostheses for the management of common bile duct occlusion by stones in elderly patients / 中华老年医学杂志

Objective To evaluate the effect of endoprostheses for short and long term management of common bile duct stones in elderly patients(70 89 years). Methods Fifty two patients over 70 years with common bile duct stones undergone endoscopic biliary stenting(Group S, 28 cases) or common bile duct exploration (Group D, 24 cases) were followed up for 14 85 months. The two groups were similar to each other in clinical manifestations. Results One patient (4 2%) died because of breath and circulation exhausting on the 3rd day postoperation in Group D. Early complications were 14 4% and 33 3% respectively ( P

Microinvasive management of post-gastrectomy acute cholecystitis / 中国普通外科杂志

Objective To study the microinvasive treatment of post-gastrectomy acute cholecystisis. Methods Teweenty-eight cases of post-gastrectomy acute cholecystitis were treated by routine non-operative method first, if cases with no apparent relief after 24h of treatment were further treated with percutanous transhepatic gallbladder puncture and drainage(PTGD) guided by ultrasonography. Results Five cases were treated by non-operative method with complete relief within 24 hours. PTGD was done successfully in all the other 23 cases.In cases with ideal bile drainage at the time of intubation, the patients had immediate marked relief of their symptoms and signs, and they fully recovered within 3~7 days.Conclusions Ultrasound guided PTGD is an effective treatment for post-gastrectomy acute cholecystitis with the advantages of microinvasion and quick patient recovery.