ABSTRACT
<p><b>OBJECTIVE</b>To investigate the feasibility and safety of membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection for advanced distal gastric cancer.</p><p><b>METHODS</b>The clinical data of 41 patients with advanced distal gastric cancer who underwent laparoscopic gastrectomy using membrane-based right-sided approach for laparoscopic suprapancreatic lymph node dissection at the Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University from January 2016 to January 2018 were retrospectively analyzed. There were 24 males and 17 females with a mean age of 56.8 years and a mean body mass index of 22.6 kg/m². Membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection contained 4 steps briefly: (1) dissection of mesenteria above the head of pancreas: the tri-junction of pancreas-duodenum was cut to expose and identify the logo of Benz;clearance of the membrane of No.5a was performed towards the left, and then expanded to the posterior layer of No.12a. (2) dissection of the V shape dorsal mesogastrium: membrane bridge at splenic artery trunk root was cut; in suprapancreatic space, clearance was performed towards to the left to the middle of the splenic artery trunk and expanded to the posterior Tolds plane upwards to the posterior phrenic angle and retroperitoneal esophagus, then the surrounding tissue of anterior abdominal aorta. (3) dissection of the U shape mesenteria:membrane bridge at common hepatic artery root was cut; mesentery was separated; the left gastric vein was freed and ligated at its root; in posterior pancreatic space, the mesentery of No.7, No.9 and No.8 was dissected in turns; the left gastric artery was high ligated and cut; the portal vein and posterior dorsal mesogastrium Toldt plane was routinely exposed; clearance was performed to right for No.8a and upward to the hepatic portal meeting at posterior mesentery No.12 plane. (4) dissection of the upper triangular area of pylorus: the trigone mesentery was cut along the upper edge of the pylorus; No.12a was swept upward along the gastric ventral mesentery; the upper boundary(No.8a) on the right side of the U-shaped membrane was joined. Intraoperative and postoperative presentations were analyzed.</p><p><b>RESULTS</b>Laparoscopic gastrectomy for advanced distal gastric cancer with membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection was successfully carried out in all the 41 patients. Distal gastric mesenteria en bloc resection was successfully performed. The operation time was (145.2±25.4) minutes and intraoperative blood loss was (53.3±18.3) ml without massive bleeding and severe complication. Number of lymph nodes dissected was 41.1±6.4, and number of suprapancreatic lymph node dissected was 23.3±3.7 without residual cancer at cut margin by pathology. Postoperative drainage volume was (65.8±21.7) ml; time to withdraw of catheter was (7.0±1.7) days; time to fluid intake was (3.5±1.8) days; postoperative hospital stay was (10.4±2.8) days; time to postoperative anal exhaust was (3.3±1.1) days. No complications, such as chyle leakage, postoperative massive bleeding, anastomotic leakage, abdominal cavity infection or gastroplegia occurred within 30 days after surgery.</p><p><b>CONCLUSION</b>Membrane-based right-sided approach of laparoscopic suprapancreatic lymph node dissection for advanced distal gastric cancer can achieve en bloc resection and conform to the radical principle of oncology, and is safe and feasible.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To explore the feasibility of laparoscopic-assisted natural orifice specimen extraction radical left colectomy.</p><p><b>METHODS</b>Retrospective analysis was performed on clinicopathological dada of 15 colorectal patients who were treated by laparoscopic-assisted anal specimen extraction radical left colectomy with self-developed surgical instrument Cai tube between January and September in 2014. Tumor location included descending colon (n=3), the junction of descending colon and sigmoid colon (n=2), the sigmoid colon (n=6) and upper rectum (n=4). Clinical efficacy of patients was observed.</p><p><b>RESULTS</b>There were no perioperative deaths or postoperative complications, such as anastomotic bleeding or leakage. The median operation time was 257 (range 103-337) min, median blood loss was 50(range 20-200) ml, median time to first flatus was 3 (range 1-5) d and median hospital stay was 14 (range 11-21) d. All the patients had good quality of life and normal defecation function without tumor recurrence or metastasis after 1-8 months of follow-up.</p><p><b>CONCLUSION</b>Laparoscopic-assisted anal specimen extraction radical left colectomy is safe and feasible.</p>
Subject(s)
Humans , Colectomy , Colon, Sigmoid , Laparoscopy , Length of Stay , Operative Time , Postoperative Complications , Quality of Life , Rectum , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To investigate the expressions of extracellular signal-regulated kinase (ERK) and the BH3-only subgroup of Bcl-2 related proteins (Bim) in multidrug-resistant hepatocellular carcinoma (HCC) cells and their association with drug resistance in the cells.</p><p><b>METHODS</b>The multdrug-resistant HepG-2 cell line was established by treatment with gradually increasing doses of ADM. CCK-8 assay was used to determine the drug sensitivity of the cells, and the expressions of MRP-1, P-gp, ERK1, ERK2, ERK5, and Bim were detected with Western blot. Bim mRNA expression level was measured using quantitative real-time PCR.</p><p><b>RESULTS</b>The drug resistance indices to ADM, 5-FU and CDDP was 6.8, 4.10, and 4.5 in HepG-2/ADM cells, respectively. The drug-resistantcells showed marked up-regulation of MRP-1, P-gp, ERK1, ERK2 and ERK5 with down-regulated phosphorylated ERK2 protein expression but no significant changes in phosphorylated ERK1 protein expression to result in a decreased ratio of P-ERK1/2 and P-ERK1/2. Bim mRNA and protein expressions were both decreased in HepG-2/ADM cells.</p><p><b>CONCLUSION</b>ERK and Bim are related to multidrug resistance in HepG-2/ADM cells.</p>
Subject(s)
Humans , ATP Binding Cassette Transporter, Subfamily B, Member 1 , Metabolism , Carcinoma, Hepatocellular , Metabolism , Down-Regulation , Drug Resistance, Multiple , Drug Resistance, Neoplasm , Extracellular Signal-Regulated MAP Kinases , Metabolism , Hep G2 Cells , Liver Neoplasms , Metabolism , Phosphorylation , Up-RegulationABSTRACT
Objective To evaluate complete mesocolic excision in laparoscopy-assisted right hemicolon carcinoma radical resection. Methods Laparoscopy-assisted right hemicolon carcinoma radical resection with complete right-side mesocolic excision was performed in 36 cases between June 2010 and July 2011 at Zhongshan Hospital,Xiamen University. Results The operations were completed successfully without conversion to open surgery.The mean operative time was (134 ±22) min.The blood loss was (95 ±53 ) ml.The median number of total lymph nodes removed was 15.7.The average time for passage of flatus was (3.1 ± 1.2) d.The postoperative complications were observed in 6 of 36 cases (17％) including lymphatic fistulas in 4 patients,pulmonary infection in 1 patient and postoperative bleeding in 1 case.Conclusions Laparoscopy-assisted complete right-side mesocohc excision can be successfully performed for right hemicolon carcinoma,and the lymphoid tissue could be eliminated maximally.The long-term results need further evaluation.
ABSTRACT
Objective: To evaluate the efficacy and the adverse reactoions of cetuximab combined with cheomotherapy (oxapliplatin or iriticon) for metastastic colorectal cancer. Methods: A total of 22 patients with metastastic colorectal cancer were treated with cetuximab combined with FOLFIRI or mFOLFOX6. The patients received cetuximab at an initial dose of 400 mg/m~2 intravenously on day 1 in the first cycle, followed by weekly infusion of 250 mg/m~2; FOLFIRI: irinotecan 180 mg/ m~2 on day 1, CF 400 mg/m~2, 5-FU bolus 400 mg/m~2, 5-FU infusion 2400 mg/m~2 over 46 hours, once every 2 weeks; mFOLF-OX6: oxaliplatin 85mg/m~2 on day 1, CF 400 mg/m~2, 5-FU bolus 400 mg/m~2, 5-FU infusion 2400 mg/m~2 over 46 hours, once every 2 weeks. The immediate response, complete response and partial response and changes in tumor marker levels were observed. Results: There were 12 PR cases, 6 SD cases, and no CR cases. The rate of (CR+PR) was 57.1% and the rate of (CR+PR+SD) was 85.7%. The adverse reactions during the theraphy were skin toxicity and neutropenia. Conclu-sion: Safe and effective for metastastic colorectal cancer, cituximab combined with oxaliplatin or irinotecan can increase the resectabiliy rate and prolong patient survival.