Impact of cytoreductive surgery on survival in gastric cancer patients with peritoneal metastasis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the survival benefit of cytoreductive surgery in gastric cancer patients with peritoneal metastasis.</p><p><b>METHODS</b>Clinicopathological data of 151 advanced gastric adenocarcinoma patients with extensive peritoneal metastasis who were identified by surgical exploration between May 2008 and April 2015 in Xijing Hospital of Digestive Diseases were analyzed retrospectively. Of all the patients, 32 cases were treated by cytoreductive surgery with local radical tumor resection and regional lymph node cleaning, combined with fluorouracil-based adjuvant chemotherapy after surgery (cytoreductive surgery combined with chemotherapy group); 39 caseswere only treated by cytoreductive surgery group(cytoreductive surgery group);23 caseswere treated bysurgical exploration combined with fluorouracil-based adjuvant chemotherapy after surgery(surgical exploration combined with chemotherapy group) and 57 cases were only treated bysurgical exploration (surgical exploration group). The overall survival of four groups were analyzed and compared.</p><p><b>RESULTS</b>Among the 151 patients, 148 (98.0%) patients were followed up. The median follow up time was 7.2 months (range 1.4-61.2). The median survival of cytoreductive surgery combined with chemotherapy group, cytoreductive surgery group, surgical exploration combined with chemotherapy group and surgical exploration group was 11.9(95% CI: 8.8-15.1) months, 7.1(95% CI: 3.2-11.1) months, 8.2(95% CI:4.6-11.8) and 5.4(95% CI:4.4-6.4) months, respectively(P < 0.01).</p><p><b>CONCLUSIONS</b>Cytoreductive surgery can prolong the survival of gastric adenocarcinoma patients with extensive peritoneal metastasis. Cytoreductive surgery combined with chemotherapy may provide more benefit for patients, and can be used as a choice of treatment in these patients.</p>

Survival rate of proximal and total gastrectomy in treatment of esophagogastric junction adenocarcinoma (Siewert II( Types) / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the survival rate of proximal gastrectomy and total gastrectomy in the treatment of esophagogastric junction (EGJ) adenocarcinoma (Siewert II( types), and to provide reference for clinical choice.</p><p><b>METHODS</b>A total of 533 patients with Siewet II( type EGJ adenocarcinoma were screened. All the patients underwent radical operations and were pathologically diagnosed as Siewet II( type EGJ adenocarcinoma in Xijing Hospital of Digestive Diseases from May 2008 to March 2014. These patients all had complete followed-up data. Finally, 234 patients were enrolled into the retrospective study, and divided into proximal gastrectomy group(117 patients) and total gastrectomy group (117 patients) based on the matching of age, sex, tumor size, TNM staging, and differentiation. The survival rate was compared between the two groups.</p><p><b>RESULTS</b>In proximal gastrectomy and total gastrectomy group, the overall 3-year survival rate was 65.6% and 62.6% respectively, and the overall 5-year survival rate was 53.8% and 44.5% respectively. No significant difference was found between the two groups (P=0.768). In subgroup analyses of 3-year survival rate between proximal gastrectomy group and total gastrectomy group, the results were as follows: 72.8% and 80.4% respectively (P=0.423) for tumor diameter ≤4 cm, 57.9% and 46.5% (P=0.239) for tumor diameter >4 cm, 83.3% and 83.3% (P=0.998) for high differentiated EGJ adenocarcinoma, 68.2% and 53.3% (P=0.270) for moderate differentiated EGJ adenocarcinoma, 56.1% and 69.6% (P=0.280) for poorly differentiated EGJ adenocarcinoma, 64.8% and 56.0% (P=0.451) for mucinous EGJ adenocarcinoma, 80.0% and 76.9% (P=0.912) for T1-2 stage EGJ adenocarcinoma, 64.3% and 60.4% (P=0.610) for T3 stage, 50.0% and 62.5% (P=0.953) for T4a stage, 92.3% and 100% (P=0.380) for stage I( EGJ adenocarcinoma, 79.6% and 66.3%(P=0.172) for stage II(, 42.6% and 49.5% (P=0.626) for stage I I(. All above differences between the two groups were not significant(all P>0.05).</p><p><b>CONCLUSION</b>Proximal gastrectomy and total gastrectomy are comparable in terms of 3-year and 5-year survival rates.</p>

Analysis of risk factors and prognosis of esophagojejunal anastomotic leakage in gastric cancer patients after curative total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To identify the risk factors of esophagojejunal anastomotic leakage (EJAL) and its impact on prognosis of gastric cancer patients after curative total gastrectomy.</p><p><b>METHODS</b>Clinical and follow-up data of 1254 gastric cancer patients who underwent radical total gastrectomy at the Department of Digestive Surgery, Xijing Hospital, from January 2012 to May 2015 were retrospectively collected. Risk factors of EJAL and prognostic factors of patients were analyzed respectively. In order to reduce the influences of other prognostic factors on survival, patients with and without EJAL were selected using Gmatch methods based on the results of prognostic factor analysis. Survival of those with or without EJAL was examined before and after match respectively.</p><p><b>RESULTS</b>EJAL occurred in 31 of 1 254 patients(2.5%). The leakage was diagnosed at a median of 6 (range, 4-12) days after surgery. Multivariate analysis demonstrated that preoperative low serum albumin(<35 g/L)(P=0.018), pulmonary insufficiency(P=0.006), long duration of operation(≥240 min)(P=0.001) were independent risk factors of EJAL. All the patients were followed up for 3-40(median 18) months. Multivariate analysis showed that age(≥65, P=0.000), intraoperative blood transfusion (P=0.016), EJAL (P=0.000), tumor location (distal, P=0.020; total, P=0.001), depth of invasion (T4, P=0.005) and lymph node metastasis (N2, P=0.002, N3, P=0.000) were prognostic predictors. Twenty-six patients with EJAL were successfully matched to 104 patients without EJAL in a ratio of 1/4 ratio. Patients with EJAL had a significantly worse overall 3-year survival rate than those without (44.3% vs. 66.7%, P=0.002).</p><p><b>CONCLUSIONS</b>EJAL after curative total gastrectomy leads to worse survival. Patients with preoperative low serum albumin, pulmonary insufficiency and long duration of operation should be taken care of during perioperative period to prevent the occurrence of EJAL.</p>

Comparison of long-term survival and postoperative complications between Billroth I( and II( reconstruction in patients with distal gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the long-term survival and postoperative complications of distal gastric cancer patients between Billroth I((BI() and Billroth II((BII() reconstruction.</p><p><b>METHODS</b>Clinicopathological data of 992 patients with distal gastric cancer who underwent D2 curative gastrectomy in our department from May 2008 to April 2015 were recorded, including 207 patients of BI( reconstruction and 785 of BII( reconstruction, were retrospectively analyzed. Patients presenting a previous history of cancer, gastric resection or cytotoxic chemotherapy, and those presenting liver or intraperitoneal tumor dissemination or unresectable infiltration into contiguous organs were excluded. Patients in BI( and BII( group were selected using gmatch methods based on age (±10 years), gender, tumor size (±1 cm), differentiated degree and depth of invasion in order to reduce the selection bias of clinicopathological characteristics. The final number of patients matched was 191 respectively.</p><p><b>RESULTS</b>Compared with BII( group, the BI( group had a significantly shorter operation time (181.7 min vs. 220.7 min, P=0.000) and a shorter postoperative hospitalization stay (7.6 days vs. 8.1 days, P=0.046). The postoperative complications including anastomotic leakage, wound dehiscence, wound infection, intraperitoneal hemorrhage, intestinal obstruction, duodenal stump fistula, pulmonary infection and fever had no significant difference(P>0.05). Three-year survival between two groups was comparable (82.9% vs. 78.7%, P=0.379).</p><p><b>CONCLUSIONS</b>Compared with BII(, BI( reconstruction is more suitable for patients with distal gastric cancer.</p>

Study on prognosis relationship between ABO blood groups of patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship of ABO blood group with the clinicopathological characteristics in patients with gastric cancer and to assess whether the ABO blood group was associated with prognosis.</p><p><b>METHOD</b>Clinicopathological and follow-up data of 2838 patients with gastric cancer who underwent radical gastrectomy in our department from June 2008 to October 2013 were analyzed retrospectively. The distribution of ABO blood group under different clinicopathological characteristics and the overall 5-year survival of ABO blood group were compared.</p><p><b>RESULTS</b>There were no significant differences in clinicopathological characteristics among patients with different ABO blood groups (all P>0.05). The 5-year overall survival(OS) rates were 57.3% for patients with blood type A, 54.7% for type B, 57.4% for type O, and 53.5% for type AB. Though there was no significance difference of survival among ABO blood groups(P=0.722), while the subgroup analysis indicated that stage III( patients of blood group Non-AB had a poorer OS compared to those of blood group AB(25.2% vs. 44.7%, P=0.014); smoking patients of blood group Non-AB had a poorer OS compared to those of blood group AB(53.4% vs. 74.9%, P=0.044).</p><p><b>CONCLUSION</b>Neither clinicopathological characteristics nor overall survival are associated with the ABO blood group, however, stage III( and smoking patients of blood group Non-AB have a poorer OS compared to those of blood group AB.</p>