Perioperative management of the pancreaticoduoden-ectomy: fluid administration and nutritional support based on complication prevention and treatment / 中华胃肠外科杂志

Pancreaticoduodenectomy(PD) has been widely accepted as one of the most complicated operation in abdominal surgery. The patients who receive PD operation always have other concurrent conditions, such as jaundice, diabetes, liver dysfunction, and malnutrition. Pancreatic fistula, biliary fistula and gastrointestinal dysfunction are common complications after PD. Proper perioperative management and fluid administration can reduce postoperative complications and the mortality.

Choice of nutritional plans for patients with gastrointestinal neoplasms / 中华胃肠外科杂志

Malnutrition is the common complication for patients with gastrointestinal neoplasms. Nutrition therapy is the key and first step, but there are some uncertain questions in the clinical practices. We will discuss some experiences on selecting nutrition plans for patients with gastrointestinal neoplasms.

Nutritional risk screening and nutrition assessment for gastrointestinal cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the nutritional status, and provide evidence for nutritional treatment option.</p><p><b>METHODS</b>A total of 452 patients with gastrointestinal cancer were selected, including 156 gastric cancer,117 colon cancer, and 180 rectal cancer. The nutritional risk screening 2002(NRS2002) was applied to grade the nutritional risk. A multi-frequency bioelectrical impedance analysis was used to measure the patients' body composition. Albumin (Alb), prealbumin(PA), transferring(Tf), retinol binding protein(RBP), red blood cell(RBC), hemoglobin (Hb), haematocrit(Hct) were measured after fasting.</p><p><b>RESULTS</b>The rate of patients with NRS2002 score more than 3 was 70.5%(110/156) for gastric cancer, 53.8%(63/117) for colon cancer, and 46.7%(86/180) for rectal cancer. The score for impaired nutritional status more than 1 for gastric cancer was higher than that for colorectal cancer(P<0.05), while patients with disease score more than 2 was less for gastric cancer(P<0.05). Body mass index(BMI), obesity degree, fat content, fat percentage, and arm circumference were lower in gastric cancer patients as compared to colorectal cancer patients(P<0.05); but protein percentage, muscle percentage, ratio of muscles of arm, and cell mass percentage were higher in gastric cancer patients(P<0.05). The proportions of patients with low Alb, PA, Tf, BC, Hb, Hct were higher for gastric cancer and colon cancer(P<0.05).</p><p><b>CONCLUSION</b>Patients with gastric cancer are prone to fat loss and therefore have a higher nutritional risk and malnutrition than those with colorectal cancer. Combination of body composition analysis and laboratory examination may achieve comprehensive evaluation of the nutritional status of patients, and provide the evidence of nutritional therapy by being combined with NRS2002 score.</p>

Metabolic disorders of fatty acids and fatty acid amides associated with human gastric cancer morbidity / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gastric cancer (GC) is one of the most common types of cancer in the world. A change in the metabolism of lipids in tumor cells could lead to the pathogenesis of cancer. In this study, we investigated fatty acid and fatty acid amide metabolic perturbations associated with GC morbidity.</p><p><b>METHODS</b>Gas chromatography/mass spectrometry (GC/MS) was utilized to analyze fatty acids (FAs) and fatty acid amides (FAAs) of GC tissues and matched normal mucosae from 30 GC patients. Acquired lipid data was analyzed using non parametric Wilcoxon rank sum test to find the differential biomarkers for GC and diagnostic models for GC were established by using orthogonal partial least squares discriminant analysis (OPLS-DA).</p><p><b>RESULTS</b>A total of 13 FAs and 4 FAAs were detected using GC/MS and 5 differential FAs as well as oleamide were identified with significant difference (P<0.05). The OPLS-DA model generated from lipid profile showed adequate discrimination of GC tissues from normal mucosae while the OPLS-DA model failed to separate GC specimens of different TNM stages. A total of 8 variables were obtained for their most contribution in the discriminating model (Variable importance in the projection (VIP) value>1.0), five of which were detected with significant difference (P<0.05).</p><p><b>CONCLUSIONS</b>FA and FAA metabolic profiles have great potential in detecting GC and helping understand perturbations of lipid metabolism associated with GC morbidity.</p>

Development of a real-time PCR method for the detection of bacterial colonization in rat models of severe acute pancreatitis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Techniques for the fast and accurate detection of bacterial infection are critical for early diagnosis, prevention and treatment of bacterial translocation in clinical severe acute pancreatitis (SAP). In this study, the availability of a real-time PCR method in detection of bacterial colonization in SAP rat models was investigated.</p><p><b>METHODS</b>Samples of blood, mesenteric lymph nodes (MLN), pancreas and liver from 24 specific pathogen-free rats (8 in a control group, 16 in a SAP group) were detected for bacterial infection rates both by agar plate culture and a real-time PCR method, and the results were made contrast.</p><p><b>RESULTS</b>Bacterial infection rates of the blood, MLN, pancreas and liver in the SAP group and the control group by the two different methods were almost the same, which were 5/16, 12/16, 15/16, 12/16 in the SAP group compared with 0/8, 1/8, 0/8, 0/8 in the control group by agar plate culture, while 5/16, 10/16, 13/16, 12/16 and 0/8, 1/8, 0/8, 0/8 respectively by a real-time PCR method. Bacterial number was estimated by real-time PCR, which showed that in the same mass of tissues, the pancreas contained more bacteria than the other three kinds of organs in SAP rats (P < 0.01), that may be due to the edema, necrosis and hemorrhage existing in the pancreas, making it easier for bacteria to invade and breed.</p><p><b>CONCLUSION</b>Fast and accurate detection of bacterial translocation in SAP rat models could be carried out by a real-time PCR procedure.</p>

Meta-analysis of laparoscopy-assisted distal gastrectomy and conventional open distal gastrectomy for early gastric cancer / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>With the application of laparoscopy, laparoscopic gastrectomy for the treatment of patients with early gastric cancer has been performed, but the safety and effectiveness of this method need to be explored. This study evaluated the safety and effectiveness of laparoscopy-assisted and conventional open distal gastrectomy for patients with early gastric cancer.</p><p><b>METHODS</b>A search of MEDLINE, EMBASE, the Chinese Biomedical Database (CBM), and Cochrane Central Register of Controlled Trials (CENTRAL) identified all the randomized clinical trials that compared laparoscopy-assisted gastrectomy with open distal gastrectomy for patients with early gastric cancer published in the last 10 years. Quality assessment was done on each trial and relevant data were extracted from qualified trials. Meta-analysis was performed using RevMan 4.2.2 software (Cochrane).</p><p><b>RESULTS</b>Six randomized controlled trials (RCTs) involving 218 patients were included. Comparing laparoscopic resection with open resection, results showed less estimated blood loss (WMD (weighted mean difference): -121.86; 95% CI (confidence interval): -145.61, -98.11; P < 0.001), earlier postoperative first flatus (WMD: -0.95; 95% CI: -1.09, -0.81; P < 0.001), and shorter durations of hospital stays (WMD: -2.27; 95%CI: -3.47, -1.06; P = 0.0002), but longer surgery times (WMD: 58.71; 95% CI: 52.69, 64.74; P < 0.001) and fewer lymph nodes dissected (WMD: -3.64; 95% CI: -5.80,-1.47; P = 0.001). There was no significant difference between the two groups in postoperative complications (OR (odds ratio): 0.57; 95% CI: 0.31,1.03; P = 0.06).</p><p><b>CONCLUSIONS</b>The short-term outcome of laparoscopy-assisted distal gastrectomy for patients with early gastric cancer is superior to the open procedure, but its long-term outcome should be proven by further outcomes of RCTs.</p>

Systematic review on safety and efficacy of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of laparoscopy- assisted distal gastrectomy (LADG) with D2 lymph node dissection for gastric cancer.</p><p><b>METHODS</b>Literature search was performed in Pubmed, Medline, EMBASE, the Chinese Biomedical Database (CBM) to identify controlled trials comparing LADG and open distal gastrectomy (ODG) for gastric cancer published between January 2005 and February 2010. A meta-analysis was performed using RevMan 5.0 software.</p><p><b>RESULTS</b>Seven controlled trials were included. One trail was randomized controlled trial. Compared to ODG, LADG had less blood loss[WMD: -132.04, 95% confidence interval (CI): -207.32 to -56.77], earlier postoperative first flatus (WMD: -0.82, 95% CI: -1.20 to -0.45], less complications [odds ratio (OR): 0.45, 95% CI: 0.26 to 0.78], shorter postoperative hospital stay (WMD: -3.63, 95% CI: -4.19 to -3.07), more harvested lymph nodes (WMD: 1.93, 95%CI: 0.36 to 3.50). There were no significant differences between the two groups in recurrence rate, metastasis rate, mortality and survival rate.</p><p><b>CONCLUSION</b>Short-term outcome of LADG with D2 lymph node dissection for gastric cancer is superior to ODG.</p>

Analyses of surgical treatment and prognosis in gastric stump cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of surgical treatment and the prognosis in gastric stump cancer patients.</p><p><b>METHODS</b>Between June 1994 and March 2004, 692 patients underwent radical operation for gastric cancer in our department. Among them, 22 cases were gastric stump cancer. Their surgical treatments, lymph node metastasis and survival were analyzed retrospectively.</p><p><b>RESULTS</b>Gastric stump cancer accounted for 3.2 % of all the gastric cancer cases in the same period. There were 4 cases of stage I, 2 cases of stage II, 6 cases of stage III and 10 cases of stage IIII respectively. Radical excision was 77.3% and combined evisceration was 50.0%. Total gastrectomy were performed in 21 cases and exploratory laparotomy in 1 case. Digestive tract was reconstructed with Roux-en-Y pattern after total gastrectomy. Radical gastric stump cancer excisions were finished with abdominal incision in 18 cases and with thoraco-abdominal incision in 4 cases. Lymph node metastasis rate was 63.6 %, including pN(0) 8 cases, pN(1) 6 cases, pN(2) 7 cases and pN(3) 1 case respectively. Average survival time was(80.2+/-17.2) months in stage I( and II( gastric remnant cancer; average survival time was(31.2+/-9.2) months in stage III( gastric remnant cancer, average survival time was (23.6+/-6.1) months in stage IIII( gastric remnant cancer, which were significantly different(all P<0.05). Between palliative operation group and standard radical excision, extended radical excision groups, well-moderate differentiated and poor differentiated adenocarcinoma groups, lymph node metastasis positive and negative groups, the differences were all significant.</p><p><b>CONCLUSIONS</b>Total gastrectomy and D(2) lymph node dissection are imperative for radical excision of gastric remnant cancer. On this base, extended lymphectomy and combined evisceration should be performed appropriately. Tumor stage, procedure pattern, lymph node metastasis and tumor differentiation affect the prognosis of patients with gastric stump cancer.</p>

Impact of width of hepatectomy margin on survival after simultaneous liver and colorectal resection for colorectal cancer liver metastasis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To elucidate an adequate hepatectomy margin for simultaneous liver and colorectal resection in colorectal cancer liver metastasis.</p><p><b>METHODS</b>Clinical data of 39 patients, undergone simultaneous liver and colorectal resection for colorectal cancer liver metastasis from August 1994 to December 2004, were analyzed retrospectively. Two groups were divided according to the width of hepatectomy margin:less than 1 cm in group A, and equal or more than 1 cm in group B. The data were analyzed and compared between the 2 groups using Kaplan-Meier survival analysis and Log-rank test.</p><p><b>RESULTS</b>There were 14 patients in group A and 25 patients in group B. No significant differences in gender, age, primary tumor invasion, lymph node metastasis, the number, distribution and size of liver metastasis, duration and blood lose of surgery were found between two groups. The median survival time was 17 months in group A, and 37 months in group B, and the overall 5-year survival rate in group B was much better than that in group A (19.8% vs 0, P<0.01).</p><p><b>CONCLUSION</b>Simultaneous liver and colorectal resection in colorectal cancer liver metastasis should be performed with a hepatectomy margin equal or more than 1 cm.</p>

Association between hypermethylation of Syk gene and clinicopathological characteristics in colorectal cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association of the methylation status and expression level of Syk gene with the clinicopathological characteristics in colorectal cancer (CRC) patients.</p><p><b>METHODS</b>Methylation-specific PCR(MSP) and RT-PCR techniques were used to analyze the methylation status and expression level of Syk gene in cancer and normal tissues of 120 CRC patients, meanwhile, association of the methylation status and expression level of Syk gene with the clinicopathological characteristics and the prognosis were studied.</p><p><b>RESULTS</b>(1) Syk gene expression was not found in 48 cancer tissues out of 120 patients and was found in all the normal tissues.The difference was significant. (2) Loss of Syk expression was found in 37 patients with Syk hypermethylation, and in 11 out of 83 patients with Syk nonmethylation. (3) The methylation status of Syk gene was correlated with the lymph node status and the Dukes stage, but not with other clinicopathological parameters. (4) The follow-up data revealed that the 3-year survival of patients with Syk hypermethylation was lower than that of patients without Syk hypermethylation(73.5% vs.95.7%,P=0.007),and postoperative recurrence rate significantly increased in the Syk hypermethylation group (32.4% vs. 8.4%,P=0.02).</p><p><b>CONCLUSION</b>Hypermethylation leads to silence of Syk gene involved in the initiation of colorectal cancer, which increases the infiltration of colorectal cancer cells, postoperative relapse and decreases the postoperative 3-year survival time.</p>

Apoptosis of human gastric cancer cells induced by omega-3 polyunsaturated fatty acids / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of omega-3 polyunsaturated fatty acids(omega-3PUFAs) on the apoptosis of human gastric cancer cell line SGC-7901 and to explore the potential mechanisms.</p><p><b>METHODS</b>Cells were treated with eicosapentaenoic acid (20:5 omega-3,EPA) or docosahexaenoic acid (22:6 omega-3, DHA) at concentrations of 10, 20 and 40 microg/ml. Cell growth and apoptosis were analyzed with MTT assay, cell morphology, DNA electrophoresis and flow cytometry. Mitochondrial membrane potential ( triangle right psi mt) was measured by fluorescent probe rhodamine 123. The distribution of cytochrome C in mitochondria and cytosol was determined by enzyme-linked immunoadsorbent assay. The composition of mitochondrial membrane phospholipid(MMP)was examined by gas chromatography.</p><p><b>RESULTS</b>Both EPA and DHA markedly inhibited the SGC-7901 cell growth and induced apoptosis in a time- and dose-dependent manner. After incubation of the cells with 40 microg/ml EPA or DHA for 24 hours, the level of Deltapsimt siginificantly decreased (P<0.001), and cytochrome C largely released into cytosol from mitochondria. The proportions of EPA and DHA in MMP rapidly elevated while that of arachidonic acid sharply decreased.</p><p><b>CONCLUSIONS</b>omega-3PUFAs inhibit the growth of gastric cancer cells through promoting apoptosis. Compositional and functional alterations in mitochondrial membrane may be an important initiator of apoptosis induced by omega-3PUFAs.</p>

Digestive tract reconstruction and postoperative management of upper abdominal multivisceral transplantation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the method of digestive tract reconstruction and postoperative management in the upper abdominal multivisceral transplantation (MVT).</p><p><b>METHODS</b>The data of a pancreatic cancer patient with multiple liver metastases, undergone the first upper abdominal MVT in Asia on May 2004, was investigated retrospectively.</p><p><b>RESULTS</b>During the operation, liver, gall bladder, pancreas, duodenum, part of jejunum, total stomach, greater and lesser omentum, and spleen were all resected from the recipient. Roux-en-Y procedure was adopted for the reconstruction of digestive tract, including closing the proximal end of donor duodenum, anastomosing recipient jejunum with horizontal part of donor duodenum, transecting the jejunum 35 cm from the anastomosis, end-to-side anastomosing the distal cut end of jejunum with the end of esophagus, and end-to-side anastomosing proximal cut jejunum with jejunum 50 cm away from esophageal anastomosis. Drainage tube was left inside duodenum and jejunum stoma was made for nutrient canal.The endocrine of pancreas was suppressed by the use of somatostatin postoperatively. Removing of nasogastric tube and duodenum draining tube were delayed. Bowel function recovered 4 days postoperatively and gradually resumed ordinary diet. One month after operation, the patient had no other complications except diarrhea.</p><p><b>CONCLUSION</b>The success of upper abdominal MVT supplies precious experience in digestive tract construction and postoperative management.</p>

The expression of VEGF-C, VEGFR-3 and its predictive value on lymph node metastasis and prognosis of gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>s To investigate the relationship between the expression of VEGF-C, VEGFR-3 and lymph node metastasis (LNM) in the gastric cancer, and explore the role of VEGF-C, VEGFR-3 in the prognosis of gastric cancer.</p><p><b>METHODS</b>Gastric cancer specimens were selected from gastric cancer database from April, 1994 to December, 2003, which were registered and followed up. The specimens were divided into two groups according to LNM existing or not. Immunohistochemistry staining was performed with anti-VEGF-C, anti-VEGFR-3 monoclonal antibody by DAB method. Their effects on prognosis of gastric cancer patients were analyzed by Kaplan-meier, Logistic and Cox Regression methods.</p><p><b>RESULTS</b>In 188 cases of gastric cancer patients, 97 patients presented with LNM and the rest did not. The positive expression rate of VEGF-C, VEGFR-3 in the group without LNM was lower than those in group with LNM, and there was significant difference between the two groups. There was significant difference in the average lymphatic vessel density between the group with LNM and the group without, and the same results were found between the group with positive VEGF-C expression and the group without.</p><p><b>CONCLUSIONS</b>VEGF-C, VEGFR-3 are over-expressed in gastric cancer patients with LNM, and the expression of VEGF-C, VEGFR-3 are important predictors for the prognosis of gastric cancer.</p>

Analysis of patterns, intervals and risk factors for recurrent gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the patterns, intervals, risk factors of recurrent gastric cancer and provide evidences for predicting and prevention of recurrence after curative gastrectomy.</p><p><b>METHODS</b>Forty-eight patients with recurrent gastric cancer after curative gastrectomy for gastric cancer who were operated on in our department from August 1994 to August 1999 were enrolled in this study. Their recurrent patterns, intervals and clinicopathologic characters of primary tumors were analyzed retrospectively and compared with 48 cases without recurrence, who were treated homeochronously and chosen randomly. Risk factors correlated with tumor recurrence and recurrent intervals were studied by univariate and multivariate analysis.</p><p><b>RESULTS</b>Univariate analysis showed that patients with metastases node in pelvic cavity, cancer invasion to serosa or more, Borrmann III or IV types were more occurred in recurrent group (P < 0.05). Multivariate analysis showed the depth of cancer invasion and Borrmann types were independently correlated with tumor recurrence after curative gastrectomy. COX regression analysis showed ascites and depth of cancer invasion were parameters dominating recurrent interval.</p><p><b>CONCLUSIONS</b>Borrmann type is a risk factor of gastric cancer recurrence, while ascites is a parameter dominating recurrent interval, and the depth of cancer invasion is both risk factor of gastric cancer recurrence and parameter dominating recurrent interval.</p>

Value of lymph node micrometastasis detected by RT-PCR assay in determining the stage of gastric carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To detect micrometastasis in regional lymph nodes using RT- PCR assay and evaluate the significance of the new assessment of nodal status in determining pN staging in gastric carcinoma.</p><p><b>METHODS</b>In addition to HE,RT- PCR assay for cytokeratin-20 gene marker was used to detect micrometastasis in 850 lymph nodes from 30 patients with gastric carcinoma who underwent gastrectomy with lymphadenectomy from Dec. 2003 to Apr. 2004.</p><p><b>RESULTS</b>The detection rate of HE staining was 27.1% (233/850), the detection rate of RT-PCR assay was 36.5% (310/850) (Pa< 0.01). Lymph node micrometastasis was further detected in 77 nodes from 14 patients. The detection rate of RT- PCR assay from the routine negative lymph nodes was 12.5% (77/617). Seven of those patients were up- staged (from IB stage to II stage, from IB stage to III A stage, from I stage to III A stage, from III A stage to III B stage, from III A stage to IV stage in one patient respectively, and from III B stage to IV stage in 2 patients).</p><p><b>CONCLUSION</b>RT- PCR assay can increase the detection rate of lymph node metastasis and have a significant impact on the staging system of gastric carcinoma.</p>

Related factors and prognosis of hepatic metastasis and peritoneal dissemination in gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the related factors and prognosis of peritoneal dissemination and hepatic metastasis in gastric cancer, and the impact of palliative surgery on the prognosis.</p><p><b>METHODS</b>The clinicopathologic and follow-up data of the patients with gastric carcinoma treated in our hospital from Aug. 1994 to Jul. 2005 were analyzed retrospectively.</p><p><b>RESULTS</b>The clinicopathologic factors correlated with peritoneal dissemination included serosal penetration, whole stomach cancer, undifferentiated type, female and hepatic metastasis, while those correlated with hepatic metastasis included Borrmann IV, lymph node metastasis and peritoneal dissemination (P< 0.05). The postoperative one-year survival rate of the patients with hepatic metastasis (H group) were lower than that of the patients with peritoneal dissemination (P group)(P< 0.05). The one- year survival rate of the patients with peritoneal dissemination undergoing palliative resection was significantly higher than that of the patients undergoing by-pass operation or feeding neostomy, and exploratory laparotomy (P< 0.05), while there was no significant difference among the three groups of the patients with hepatic metastasis.</p><p><b>CONCLUSIONS</b>The short-term prognosis of the patients with hepatic metastasis is poorer than that of the patients with peritoneal dissemination. Palliative resection could improve the short-term survival rate of the patients with peritoneal dissemination, while it had no significant impact on the survival rate of the patients with hepatic metastasis.</p>

Disciplinarian of lymph node metastasis and effect of paraaortic lymph nodes dissection on clinical outcomes in advanced gastric carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the disciplinarian of lymph node metastasis and evaluate the effect of paraaortic lymph nodes dissection on the clinical outcomes in advanced gastric carcinoma.</p><p><b>METHODS</b>One hundred and twenty-six patients who underwent D(3) (including D(3)(+)) radical resection (group D(3)) and 146 patients who underwent D(2) radical resection by the same surgical team (group D(2)) for advanced gastric cancer were enrolled in the present study. The dissected lymph nodes were grouped according to the definition of Japanese Research Society for the Study of Gastric Cancer (JRSGC) (Edition 13th). The lymph node metastasis was analyzed in group D(3). The clinicopathological characteristics and clinical outcomes were compared between the two groups.</p><p><b>RESULTS</b>There were no differences in age, sex, tumor location, Borrman type, histological type and TNM stage between group D(2) and group D(3) (P > 0.05). The No16 lymph node metastatic rate was 3.8%, 22.3%, 46.8% and 32.1% in T(1), T(2), T(3), T(4) stage tumors respectively, 16.3% and 69.5% in the patients with negative and positive serosal invasion respectively; there were no differences in operative mortality (2/126 vs 2/146) and surgical complications (4/126 vs 6/146) between group D(2) and group D(3) (P > 0.05). The 5-year survival rate was 66.5% in group D(3) and 40.2% in group D(2) (P< 0.01). The 5-year survival rates of the patients with I, II, IIIa, IIIb and IV stage tumors who were No16 lymph nodes negative were 94.8%, 95.6%, 72.1%, 58.6%, 59% respectively in group D(3), and 42%, 36%, 27%, 35.6%, 16.3% respectively in group D(2). The 5-year survival rate of the patients with No16 (+) lymph nodes less than 3 was higher than that of the patients with No16(+) lymph nodes more than 3.</p><p><b>CONCLUSIONS</b>No16a2 and No16b1 are the common locations of lymph node metastasis in advanced gastric cancer. The paraaortic lymph node metastasis closely is related with the depth of tumor invasion and serosal invasion. Paraaortic lymph nodes dissection (D(3) or D(3)(+) radical resection) improves the 5-year survival rate of the patients with No16 (-) and No16 (+) lymph nodes less than 3.</p>

Risk factors of elderly patients with total gastrectomy for gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze the relative risk factors of elderly patients with total gastrectomy for gastric cancer.</p><p><b>METHODS</b>The risk factors for hospital death and postoperative complications in 131 elderly patients undergoing total gastrectomy for gastric cancer from Aug. 1994 to Aug. 2004 were analyzed retrospectively.</p><p><b>RESULTS</b>The risk factors for hospital death and postoperative complications included coexistent diseases, hemoglobin level less than 80 g/L, albumin level less than 35 g/L, body mass index(BMI) less than 18.5 kg/m (2), intraoperative blood loss more than 1000 ml, operating time longer than 5 h, combined resection of the spleen or pancreas. The relative risks were 1.57, 1.74, 2.97, 4.23, 2.21, 2.28, 3.80 respectively for hospital death, and 1.50, 1.90, 2.38, 2.12, 2.45, 1.66, 3.41 for postoperative complications.</p><p><b>CONCLUSION</b>The risk factors of the elderly patients with total gastrectomy for gastric cancer should be considered carefully during the perioperative period. It can increase the security of the procedure to control these risk factors.</p>

Clinicopathological analysis of synchronous liver metastasis in gastric cancer and evaluation of surgical outcomes / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze the clinicopathological factors affecting synchronous liver metastasis in gastric cancer,and evaluate its surgical outcome.</p><p><b>METHODS</b>Clinical data of 44 patients with synchronous hepatic metastasis from gastric cancer from Aug. 1994 to Feb. 2004 were reviewed retrospectively, and compared with those of 576 gastric cancer patients without hepatic metastasis to analyze the clinicopathological factors affecting synchronous liver metastasis from gastric cancer. The survivals after radical resection, palliative and exploratory operation were compared.</p><p><b>RESULTS</b>Univariate analysis revealed that ascites, pelvic and peritoneal seeding, serosal invasion, lymph node metastasis, involvement of neighboring organs, Borrmann types,depth of infiltration were correlated with synchronous hepatic metastasis from gastric cancer (P< 0.01). Logistic regression showed peritoneal seeding (P=0.003, OR=1.629), serosal infiltration (P=0.000, OR=3.000), lymph node metastasis (P=0.081, OR=1.689) were independent risk factors for synchronous hepatic metastasis from gastric cancer. Sixteen (36.4%) patients received radical excision, 15 (34.1%) patients palliative operation, and 13 (29.5 %) patients exploratory operation,and the median survival times were 19.5, 11.0 and 6.2 months respectively (P< 0.05).</p><p><b>CONCLUSIONS</b>Peritoneal seeding,serosal infiltration, lymph node metastasis are most important risk factors for synchronous hepatic metastasis from gastric cancer. Radical resection of gastric primary lesion and hepatic metastases can significantly prolong survival time.</p>

Analysis of long-term results of radical gastrectomy combining splenectomy for gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the influence of radical excision combining splenectomy on prognosis of the patients with gastric cancer.</p><p><b>METHODS</b>Between June 1994 and March 2004, 692 patients were operated on for gastric cancer and registered into gastric cancer database. Radical excision (D2, D3 or D4) combining splenectomy for gastric cancer was performed in 45 cases. 343 cases were selected simultaneously for comparison according to the resembling rules in sex, age, tumor size, location, serosa invasion, Borrmann type and range of lymph node dissection. Clinicopathological factors affecting lymph node metastasis, patterns of lymph node metastasis, 5-year survival rate after radical excision combined with splenectomy for gastric cancer were compared.</p><p><b>RESULTS</b>Lymph node metastasis rate of splenic hilus was 15.6 percent. Among them, upper, middle and lower domain is 11.5 percent, 33.3 percent and zero respectively. It was significantly different between gastric adenocarcinoma in proximal and body of stomach and that in distal stomach, poor differentiation and adenocarcinoma anaplastic and well and moderately differentiation adenocarcinoma, Borrmann III and IV types and Borrmann I and II types, infiltrated depth in T(3) and T(4) and infiltrated depth in T(1) and T(2), clinical stages III and IV and clinical stages I and II. The average and median survival time between radical gastrectomy only and radical gastrectomy combining splenectomy for gastric cancer at stage I and II patients were significantly different, but at stage III and IV patients not significantly different.</p><p><b>CONCLUSIONS</b>Spleen should be reserved for patients with gastric cancer at stage I and II, and radical excision combining splenectomy could only be performed at stage III and IV patients with cancer infiltrating body and tail of the pancreas, or lymph nodes metastasis in the splenic hilus. Indication of radical excision combining splenectomy for gastric cancer must be further study to clarify its efficacy.</p>