Influence of LMR and LMR/LDH on Prognosis of Primary Waldeyer's Ring Diffuse Large B-cell Lymphoma / 肿瘤防治研究

Objective To investigate the predictive value of peripheral blood LMR and LMR/LDH on the prognosis of primary Waldeyer's Ring DLBCL patients. Methods We collected 71 patients with primary Waldeyer's Ring DLBCL. The ROC curve was used to determine the optimal critical values of LMR and LMR/LDH before treatment. The chi-square test was used to analyze the constituent ratio and rate of high and low LMR groups as well as high and low LMR/LDH groups. Kaplan-Meier method was used to calculate survival rate. Log rank method and Cox risk regression model were used for univariate and multivariate analyses, respectively. Results The optimal critical values of LMR and LMR/LDH were 2.97 and 1.56, respectively. The prognosis of patients in the high LMR group was significantly better than that in the low LMR group (P < 0.001). The prognosis of patients in the high LMR/LDH group was significantly better than that in the low LMR/LDH group (P < 0.001). Univariate analysis showed that age, B symptoms, clinical stage, treatment efficacy, IPI score, LDH level, LMR and LMR/LDH were important factors that influenced the prognosis of early-stage Waldeyer's Ring DLBCL. Multivariate analysis showed that the age, clinical stage and LMR/LDH were independent prognostic factors. Conclusion LMR and LMR/LDH before treatment may have certain value in predicting the prognosis of Waldeyer's Ring DLBCL patients.

Efficacy analysis of laparoscopic surgery for primary local gastric and intestinal gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and short-term efficacy of laparoscopic resection of primary local gastric and intestinal gastrointestinal stromal tumors(GIST).</p><p><b>METHODS</b>Clinicopathological data of 26 patients with GIST, 20 located at the stomach and 6 at the intestine, undergoing laparoscopic complete resection from October 2010 to April 2013 were retrospectively analyzed.</p><p><b>RESULTS</b>Hand-assisted laparoscopic surgery was performed in 3 patients with gastric GIST, while the other 23 underwent regular laparoscopic surgery. All the procedures were performed successfully without conversion to open operation. According to tumor location and growth types, gastric local resection was performed in 18 cases, distal gastrectomy in 2 cases and intestinal segmental resection in all 6 cases of intestinal GIST. The mean diameter of tumor was (4.5±1.6) cm. The mean operational time was(96.2±28.2) min, with a mean blood loss of (49.6±38.6) ml. Postoperative bowel function recovery time was (2.3±0.7) d and the length of postoperative hospital stay was (6.8±1.9) d. Bleeding from gastrointestinal tract developed in 1 patient after resection of intestinal GIST. Postoperative pathology indicated very low risk of GIST in 1(3.8%), low risk in 13(50.0%), intermediate in 9(34.6%) and high risk in 3(11.5%) patients, respectively. After a follow-up ranging form 3 to 32 months, no recurrence or death was found.</p><p><b>CONCLUSION</b>Laparoscopic surgery of primary local GISTs from stomach or intestine is safe and feasible in selected patients, with less invasiveness, rapid recovery, and favorable short-term outcomes.</p>

Evaluation of para-aortic nodal dissection for locoregionally advanced gastric cancer with 1-3 involved para-aortic nodes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Prophylactic para-aortic nodal dissection (PAND) has no proven benefits for potentially curable advanced gastric cancer. However, the value of therapeutic PAND for involved para-aortic nodes (PANs) in patients with locally advanced gastric cancers has not been determined yet.</p><p><b>METHODS</b>Between 1998 and 2010, 157 gastric cancer patients with 1-3 involved PANs underwent extended D2 (D2+) lymphadenectomy plus PAND (PAND group, n = 69) or extended D2 lymphadenectomy alone (non-PAND group, n = 88). The clinicopathologic features and prognostic data were compared between the two groups. A propensity score-adjusted analysis was used for a balanced comparison.</p><p><b>RESULTS</b>The rate of PAN metastasis was 40.6% (28/69) in the PAND group. The 5-year survival rate was significantly higher in the PAND group than in the non-PAND group (43.7% vs. 31.8%, P = 0.044). Compared to the non-PAND group, the death hazard ratios in the PAND group were 0.45 (95% CI 0.274-0.739; P = 0.002) and 0.536 (95% CI 0.328-0.861; P = 0.0097) by multivariate analysis without and with propensity score adjustment respectively. Recurrence rate at 5 years was 39.1% in the PAND group and 43.2% in the non-PAND group (P = 0.628).</p><p><b>CONCLUSION</b>Extended D2 lymphadenectomy plus PAND is associated with superior outcomes for advanced gastric cancer patients with 1-3 involved PANs.</p>

Evaluation of the rationality of current T staging of gastric cancer with transverse mesocolon invasion / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the rationality of T staging of gastric cancer with transverse mesocolon invasion.</p><p><b>METHODS</b>Data of 808 patients with primary gastric cancer undergoing surgical treatment was screened from the Data base of Gastric Cancer of Sun Yat-sen University, from April 1996 to October 2009. According to the information of transverse mesocolon invasion, all cases were divided into groups NOI (T4a stage, non organ invasion, n = 638), NTMI (T4b stage, non transverse mesolon invasion, with organ invasion, n = 126), and TMI (transverse mesocolon invasion, n = 44). The clinicopathological features, surgical procedure and prognosis were compared among the three groups.</p><p><b>RESULTS</b>No significant difference was found in gender, age, lymph node metastasis, hepatic metastasis, tumor's Borrmann type, histological type, differentiation degree, value of serum CEA among the 3 groups (all P > 0.05). In the groups NOI, NTMI and TMI, the ratio of mean tumor diameter ≥ 5 cm was 39.0% (249/638), 61.1% (77/126) and 54.5% (24/44), respectively; the ratio of distal metastasis was 11.9% (76/638), 30.2% (38/126) and 43.2% (19/44), respectively; the ratio of peritoneal metastasis was 8.2% (52/638), 26.2% (33/126) and 38.6% (17/44), respectively; the ratio of TNM IV stage was 25.4% (162/638), 84.7% (107/126) and 93.7% (41/44), respectively; and the ratio of radical resection was 92.0% (587/638), 69.8% (88/126) and 77.3% (34/44), respectively; all with significant differences (P < 0.01), and the results of pairwise comparisons (Bonferroni correction, significant level α = 0.05/3 = 0.0167) showed that these parameters were significantly different between groups NOI and TMI (P < 0.0167), but non-significant between groups NTMI and TMI (P > 0.0167). The median survival time was 42.0, 16.4 and 19.0 months in the groups NOI, NTMI and TMI, respectively (P < 0.01), and the results of pairwise comparison showed that the prognosis were significant different between the groups NOI and TMI (P < 0.01), but non-significant between the groups NTMI and TMI (P > 0.05). In the cases who received radical resection, the median survival time was 47.9, 23.5 and 21.4 months in the groups NOI, NTMI and TMI, respectively (P < 0.01), and the results of pairwise comparison showed that the prognosis was significantly different between the groups NOI and TMI (P < 0.05), but not significant between groups NTMI and TMI (P > 0.05).</p><p><b>CONCLUSIONS</b>The tumor size, distal meatastasis, peritoneal metastasis, TNM stage, surgical procedure and prognosis of gastric cancer with transverse mesocolon invasion are similar to that of T4b gastric cancer, but are significantly different from that of T4a gastric cancer. Gastric cancer with transverse mesocolon invasion should be reclassified as T4b stage.</p>

Application of sunitinib in the treatment of advanced gastrointestinal stromal tumor / 中华消化外科杂志

Objective To investigate the efficacy of sunitinib in the treatment of patients with imatinibresistant advanced gastrointestinal stromal tumor (GIST).Methods The clinical data of 45 patients with imatinib-resistant advanced GIST who received the treatment of sunitinib (37.5 mg/d) at the First Affiliated Hospital of Sun Yat-Sen University from March 2008 to June 2012 were retrospectively analyzed.The mutation of c-kit and platelet-derived growth factor receptor α (PDGFRα) was detected,and the efficacy of imatinib was assessed after the treatment for 3 months,and factors influencing the survival were analysed.The survival rate was calculated using the Kaplan-Meier method,survival analysis was done using the one-way analysis of variance,and multivariate analysis was done using the COX regression model.Results The median time of treatment with sunitinib for the 45 patients was 11.0 months (range,4-37 months).The complete remission rate,partial response rate,rate of stabilized condition and disease progression rate were 15.6％ (7/45),8.9％ (4/45),46.7％ (21/45) and 28.9％ (13/45) after the treatment with sunitinib for 3 months.All the patients with clinical (imaging) complete remission received surgery for metastatic lesions or B-ultrasound guided ablation for single liver metastasis before the treatment with sunitinib.The most common grade 3 or 4 adverse reactions of sunitinib were hand-foot syndrome and anemia.C-kit and PDGFRα mutational analysis were carried out.C-kit exon 9 mutation was detected in 9 patients,c-kit exon 11 mutation in 21 patients,and no mutation was detected in 12 patients.The median progression-free survival time was 8.0 months (range,4.1-11.9 months),and the median overall survival time was 25.0 months (range,13.4-36.6 months).The results of univariate analysis showed that the primary lesion sites and mutational status of primary lesions were factors influencing the progression-free survival and overall survival (x2=5.967,6.622 ; 7.965,8.765,P ＜ 0.05).The results of multivariate analysis showed that only the mutational status of c-kit of primary lesions was the independent factor influencing the progression-free survival and overall survival (Wald =6.540,7.205,P ＜ 0.05).The progression-free survival and overall survival of patients with c-kit exon 9 mutation and patients with no gene mutation were significantly longer than patients with c-kit exon 11 mutation (x2 =7.965,8.765,P ＜ 0.05).Conclusion Sunitinib with a dosage of 37.5 mg/d could effectively treat patients with imatinib-resistant advanced GIST.A better survival is observed in patients with c-kit exon 9 mutation or with no gene mutation when compared with patients with c-kit exon 11 mutation.

Pancreaticojejunostomy versus pancreaticogastrostomy following pancreaticoduodenectomy: a retrospective study / 中华肝胆外科杂志

Objective To compare the feasibility and safety of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Methods A retrospective study was performed on 37 patients who underwent pancreaticoduodenectomy for duodenal carcinoma or pancreatic head tumors at the First Hospital of Sun Yat-sen University from April 2006 to December 2010.Pancreatic anastomosis was carried out either using pancreaticogastrostomy (n＝ 19) or pancreaticojejunostomy (n=18).The operative time,intraoperative bHood Hoss,postoperative pancreatic Heak,mortaHity and Hength of hospitaH stay were compared between the two groups. ResuHts The mean operative time,intraoperative bHood Hoss,incidence of pancreatic fistuHa,mortaHity rate and mean Hength of postoperative hospitaH stay were (372.1 ±79.5) min vs (351.0±69.2) min; (693.5± 412.8) mH vs (645.1±488)ml; 10.5％ (2/19) vs 11.1％ (2/18); 5.3％ (1/19) vs 5.6％ (1/18); and (17.5± 8.9)d vs (16.1± 7.6)d,respectively.The differences between the two groups were not statistically significant.Conclusion Pancreaticogastrostomy appears to be a feasible and safe alternative to pancreaticojejunostomy for the pancreatic remnant after pancreaticoduodenectomy.

Clinical randomzied study of postoperative radiochemotherapy compared with chemotherapy alone in the treatment of locally advanced gastric cancer / 中华放射肿瘤学杂志

ObjectiveTo investigate the efficacy and toxicity of postoperative radiochemotherapy compared with chemotherapy alone in the treatment of locally advanced gastric cancer.MethodsA total of 83 patients with resected adenocarcinoma of the stomach were randomly assigned to postoperative radiochemotherapy group (RCT) ( n =43 ) or chemotherapy alone group (CT) ( n =40 ).Patients in RCT group received radiotherapy concurrent with capecitabine chemotherapy then followed by 4 - 6 cycles of FOLFOX4 chemotherapy.The total dose of radiation was 45 Gy.The dose of capecitabine was 1600 mg/m2per day.In the CT group,patients received 6 - 8 cycles FOLFOX4 chemotherapy.Survival was analyzed using Kaplan-Meier method and Logrank test. Results The follow-up rate was 96％. The number of patients who had a minimum of 2-,3-year follow-up time were 37,12 in the RCT group and 31,10 in the CT group.The 1-,2-,3-year local control rates for RCT and CT groups were 100％,97％,94％ and 95％,87％,73％ (x2 =4.54,P =0.033),respectively.The 1-,2-,3-year survival rates were 98％,86％,81％ in the RCT group,with 93％,80％,64％ in the CT group ( x2 =3.96,P =0.047 ).The incidence of grade 3hematological toxicity in the RCT and CT group was 23％ vs 15％ ( x2 =0.93,P =0.630 ),and grade 3gastrointestinal toxicity was 16％ vs 10％ ( x2 =0.95,P =0.624 ). Conclusions Compared with chemotherapy alone,postoperative radiochemotherapy can improve survival of locally advanced gastric cancer patients with acceptable toxicities.

The effect of eicosapentaenoic acid on the proliferation and apoptosis of gastric cancer cells / 中华临床营养杂志

ObjectiveTo observe the effect of eicosapentaenoic acid (EPA) on the proliferation and apoptosis of human gastric cancer cells and to explore the potential mechanism involved.MethodsHuman gastric cancer cell lines SGC-7901 and MGC-803 were treated with EPA at 10,20,40 μg/ml for 24-72 hours.The inhibition of cell proliferation was evaluated by methyl thiazolyl tetrazolium assay.The apoptosis and the distribution of cell cycle were analyzed by flow cytometry.Mitochondria membrane potential was determined with a fluorescence probe rhodamine 123.Cellular distribution of cytochrome C was quantitatively detected with enzyme-linked immunosorbent assay.Caspase-3 activity was measured with spectrofluorometry.ResultsAfter incubation with 10-40 μg/ml EPAfor 24-72 hours,the proliferation of human gastric cancer cells was markedly inhibited in a time-dependent manner.The treatment of 40 g/ml EPA for 72 hours increased the proportion of G0/G1 phase cells in both SGC-7901 and MGC-803 (P=0.006,P=0.009).In SGC-7901 and MGC-803 cells incubated with 40 μg/ml EPA for 24 hours,mitochondria membrane potential decreased significantly (P =0.001,P =0.047 ); cytochrome C level significantly declined in mitochondria (P=0.001,P=0.000) but increased in cytosol (P =0.001,P=0.000).In SGC-7901 cells,the apoptotic effector caspase-3 activity increased time-dependently along with incubation with 40 g/ml EPA.ConclusionEPA could inhibit the proliferation and promote the apoptosis of human gastric cancer cells through inducing cell cycle arrest and activating intrinsic death pathway mediated by mitochondria.

Clinicopathology and prognosis of gastric cancer patients with perigastric soft tissue involvement / 中华普通外科杂志

ObjectiveTo analyze the clinicopathological features and prognosis of gastric cancer patients with metastatic nodules of perigastric soft tissue. MethodsIn this study,1025 cases of gastric cancer received radical resection.According to the metastasis of perigastric soft tissue,patients were divided into metastatic group ( group MP,n =334 ),non-metastatic group ( group NMP,n =691 ).The clinicopathological features and prognosis were compared between the two groups. ResultsIn group MP,the ratio of upper,middle,lower,total gastric cancer was 25.8％,22.0％,51.4％,0.9％ and the ratio in group NMP was 33.2％,21.3％,41.3％,4.2％ respectively,showing significant higher ratio of upper and total gastric cancer in MP group(P =0.000). In group MP 47.3％ cases with tumor size ≥5 cm,significantly higher than that in NMP group(27％ ) (P =0.000).Lymph node metastatic ratio between 21％ -40％ and 41％ -100％ was found in 24.4％ and 37.3％ in MP group respectively,significantly higher than that of 12.9％,10.8％ in NMP group(P =0.000).20.1％ cases had distal metastasis in group MP,significantly higher than that of 4.1％ in group NMP(P=0.000).In group MP and NMP group,the ratio of Borrmann infiltration typing was 82.1％ vs.64.6％,the ratio of positive CEA was 21.2％ vs.11.4％,the ratio of lower or undifferentiation typing was 78.7％ vs.64.2％,all with significant difference (P =0.000 ). COX regression analysis showed the infiltration depth,organic invasion,lymph node metastatic ratio,M staging,Borrmann typing,metastatic nodules was the independent prognostic factors.Prognosis was significantly poorer in the cases with perigastric soft tissues than without ( P =0.000 ).Stratified analysis showed that irrespective of tumor size,infiltration depth,lymph node metastatic ratio,CEA value,Borrmann typing,differentiation degree,the mean survival time was significantly shorter in MP group than that in group NMP(P ＜ 0.005).In cases without distal metastasis,the prognosis was significant poorer in group MP than that in group NMP ( P =0.000 ),however,there was no significant difference between two groups in cases without distal metastasis ( P =0.076).ConclusionsPerigastric soft tissue metastasis was common in gastric cancer,more frequently seen in tumor ≥5 cm,or with organic invasion,lymph nodemetastaticration ≥ 21％, distalmetastasis, Borrmanninfiltrationtyping, loweror undifferentiation typing,positive CEA. Perigastric soft tissues metastasis was the independent prognotic factor for gastric cancer.

Spleen and splenic vessel-preserving distal pancreatectomy / 中华普通外科杂志

Objective To study the feasibility, safety and clinical effects of spleen and splenic vessel-preserving distal pancreatectomy. Methods A retrospective study was performed in 26 patients undergoing distal pancreatectomy for benign or low grade malignant disease with splenectomy (n = 13) or splenic preservation (n = 13 ) at the First Hospital of Sun Yat-sen University and Guangdong General Hospital from May 2002 to April 2009. Results All 26 pancreatectomy with splenectomy or splenic preservation were performed successfully. There was no statistically significant difference between two groups in average operative time[(172±47) min vs. (157±52) min, P ＞ 0.05 ], intraoperative estimated blood loss [( 183 ± 68 ) ml vs. ( 160 ± 51 ) ml, P ＞ 0.05 ], incidence of noninfectious and infection complication and postoperative hospital stay [(10.1±2.2) d vs. ( 12. 1 ± 4. 6 ) d, P ＞ 0.05 ]. The platelet counts examined one week after operation were significantly higher in the distal pancreatectomy with splenectomy group than that in spleen-preserving group [(37.3 ± 12.8)×109/L vs. (54.7 ± 13.2) × 109/L, P＜0.05 ]. Conclusions Spleen-preserving distal pancreatectomy appears to be a feasible and safe procedure in selected cases of benign or low-grade pancreatic malignant disease necessitating a distal pancreatectomy.

Fast track surgery in elective operation for colorectal carcinoma / 中华普通外科杂志

Objective To investigate the clinical application of fast track surgery in patients undergoing elective colorectal carcinoma surgery. Methods Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: fast-track group (35 cases) and conventional care group (35 cases). Results Sixty-two patients finished the study, 32 cases in fast-track group and 30 cases in conventional care group. The median and average time to the first passage of flatus (2±1 vs. 4±2, P<0.01), the first passage of stool (3.8±1.6 vs. 6.4±2.5, P=0.0007), resumption of normal diet [(4±2) vs. (8.2±2.2), P<0.01] and the length of postoperative stay (6±1 days vs. 11.7±3.8 days, P<0.01) were much shorter in the fast-track group than in the conventional care group. The preoperative incidence of thirst (2/32 vs. 23/30, P<0.01), hunger (5/32 vs. 20/30, P<0.01) and postoperative infectious complications (2/32 vs. 8/30, P=0.04) were much lower in the fast-track group than in the conventional care group. Conclusion Fast track surgery in patients undergoing elective colorectal resection was safe and effective.

The management of colorectal cancer with synchronous liver metastases / 中华普通外科杂志

Objective To investigate the clinical pathologic characters of colorectal cancer with simultaneous hepatic metastasis and the prognosis. Methods From Aug. 1994 to Dec. 2006, 2019 cases of colorectal carcinoma were admitted, among them there were 166 patients of colorectal cancer with synchronous liver metastases receiving surgical therapy. Results were analyzed retrospectively using the software of SPSS. Results These 166 patients with synchronous liver metastases from colorectal cancer accounted for 8.1% of all 2019 patients of colorectal cancer admitted. Multivariate analysis demonstrated that CEA level before surgery、depth of invasion、 pathological type and Ducks' stage were the key risk factors predicting simultaneous liver metastasis from colorectal cancer. The survival rates at 1, 3 and 5 years were 69%, 21%, and 9% respectively. There was significant difference among the different liver metastasis group of H1, H2 and H3(X2=23.35, P<0.01). The survival rates of patients undergoing radical resection was higher than those undergoing palliative resection (PR)and by-pass operation or feeding neostomy(BP/ FN)(X2= 21.18,P<0.01). PR improved short-term prognosis but did not improve long-term survival compared with BP/FN group(P=0.13). Conclusion Colorectal cancer with synchronous liver metastases has poor clinic pathological characters. Different degree of liver metastasis result in different prognosis.Radical resection leads to a better prognosis. Palliative resection can improve short-term prognosis and life quality but can't improve long-term survival.

Early feeding after elective open colorectal surgery / 中华临床营养杂志

e and feasible for postcolectomy patients.

Relationship between mutated k - ras and biological behavior of colorectal cancer / 中国病理生理杂志

AIM: To investigate mutations of oncogene k-ras in colorectal cancer tissues and the relationship between mutations of k - ras and biological behavior of colorectal carcinoma. METHODS:The specimens of 123 patients with colorectal cancer were collected. Real - time fluorescence quantitative PCR were performed to detect k-ras mutations at codon 12 and codon 13 of exon 1, and the results were analyzed with the corresponding clinical pathological data. RESULTS: Among 123 colorectal cancer cases, point mutations were detected in 53 cases (40.8% ) , point mutations at codon 12 were found in 42 (34.1 % ) cases, and 11(8.9% ) cases at codon 13.No closely relationship between mutations of k-ras and tumor size, location, invasive depth and differentiation extent was observed. The rate of k-ras mutation in the cases with more invaded lymph nodes was higher than that in the cases without invaded lymph nodes ( P < 0.05 ) , and the rate of k-ras gene mutation in the cases with hepatic metastases was higher than that in no hepatic metastases (P <0.05). The rate of k - ras gene mutation was higher in TNM staging Ⅲ/Ⅳ than that in Ⅰ/Ⅱ( P < 0.05 ). CONCLUSION: Mutation of oncogene k-ras plays an important role in the carcinogenesis and development of colorectal cancer, and it is closely associated with invaded lymph notes and hepatic metastases, suggesting that mutation of k- ras indicates a poor prognosis.

The effect of operative modality on the prognosis of gastric carcinoma patients suffering from different types of intra-abdominal metastasis / 中华普通外科杂志

Objective To study the effect of operative modalities on the prognosis of gastric carcinoma patients suffering from various types of intra-abdominal metastasis. Methods In this study, 150 cases of gastric cancer with abdominal metastasis screened from data base, were divided by the location into peritoneal dissemination group (n=106), hepatic metastasis group (n=19) and both peritoneal dissemination and hepatic metastasis group (n=25). The surgical interventions include total resection, palliative resection and no resection. The clinicopathological parameters and prognosis were analyzed. Results The total tumor resection rate in peritoneal dissemination group (48.1%) and hepatic metastasis group (63.2%) was significantly higher than that in both peritoneal and hepatic metastasis group (20.0%), with the mean survival time (months) being 31.1, 12.8, 9.7 respectively (P<0.05). In peritoneal group, the mean survival (months) for tumor total resection, palliative and no resection subgroup was 46.3,1.7,4.8 respectively (P<0.05), whereas in hepatic metastasis group, the mean survival (months) was 17.2,4.0,5.4 respectively (P<0.05), in both peritoneal and hepatic metastasis group, the mean survival (months) was 11.2,8.9,5.0 respectively (P>0.05). Lymph nodes resection significantly prolonged survival in peritoneal dissemination group. Conclusions The prognosis of gastric cancer with peritoneal dissemination is better than with hepatic metastasis. Tumor total resection and lymph node dissection significantly improve the survival of patients suffering from peritoneal or hepatic dissemination.

Cox Regression Analysis of Factors Influencing Postoperative Survival Rate of Gastric Cancer Patients / 中国普外基础与临床杂志

Objective To study the influence of clinicopathologic characteristics and surgical treatment of gastric cancer on patients' survival rate.Methods From Apr.1994 to Aug.2005, the data of 759 gastric cancer patients concerning surgical treatment, pathological diagnosis and outcome were collected. Retrospective analysis of the results was made, 3-year and 5-year survival rates were calculated by Kaplan-Meier curve method, univariate analysis was done through Log-rank and multiple factors comparison through Cox regression analysis, and follow-up duration was 4-131 months.Results Single factor analysis indicated that age,tumor location,diameter of tumor, Borrmann type, type of histology, TNM stage, depth of infiltration, lymph node metastasis, liver metastasis, peritoneal dissemination, blood of transfusion during operation, extent of the radical cure of the tumor and excision techniques were significantly influential factors for the prognosis of patients. Cox regression analysis showed that tumor location, diameter of tumor,depth of infiltration, lymph node metastasis,liver metastasis, TNM stage, peritoneal dissemination, blood transfusion during operation, extend of the radical cure of the tumor and excision techniques were independent factors influencing the postoperative survival rate.Conclusion Independent factors influencing the postoperative survival rate include tumor location, diameter of tumor, lymph node metastasis, infiltration depth of the tumor, pathological classification, liver metastasis, peritoneal dissemination, and TNM stage, extent of the radical cure of the tumor, lymphanodectomy techniques and blood transfusion during operation are also important factors.

The effect of FasL expression on pancreatic islet allografts / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the immune privilege induced by the Fas ligand (FasL) expressed by cotransplanted testicular Sertoli cells in islet allografts, and the effect of FasL gene transfection on islet cells in pancreatic islet allografts.</p><p><b>METHODS</b>Allogeneic islets and testicular cells were cotransplanted into diabetic recipients. Pancreatic islets were infected with the recombinant adenovirus, AdV-FasL, and transplanted into diabetic recipients. Allograft survival, islet function, apoptosis of infiltrative lymphocytes in allografts and gene transfected islet allografts were analyzed.</p><p><b>RESULTS</b>All animals receiving islet allograft alone returned to a diabetic state in a few days (mean survival time 6.3 +/- 0.6 days). When the quantity of testicular cells cotransplanted with islets increased to 1 x 10(7), all animals remained normoglycemic throughout the follow-up period (60 days). FasL expression by cotransplanted Sertoli cells induced apoptosis of activated lymphocytes. Rejection of allografts in the FasL gene transfer group was accelerated and allograft survival was shortened to 3.4 +/- 0.2 days (P < 0.05). Pancreatic islets infected with AdV-FasL demonstrated positive staining for FasL at 24h after transplantation, with increased intensity at 48h. Apoptosis assays of pancreatic islet allografts at 24h and 48h revealed apoptosis of transfected islets.</p><p><b>CONCLUSIONS</b>FasL-expressing testicular Sertoli cells can induce apoptosis of activated lymphocytes. Cotransplantation of testicular cells allows long-term survival of allogeneic islets because of immune privilege, but the direct expression of FasL on islet allografts infected with AdV-FasL accelerates islet rejection via islet apoptosis and granulocyte infiltration.</p>

Comparison of colonic J-pouch and straight coloanal anastomosis after low anterior resection for rectal carcinoma: a meta-analysis of 8 randomized trails / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of colonic J-pouch coloanal anastomosis after low anterior resection for mid or low rectal cancer on improving defecation and anorectal physiology.</p><p><b>METHODS</b>To make a meta-analysis, prospective randomized controlled trial of with or without colonic J-pouch after low anterior resection for mid or low rectal cancer was conducted. The key words included rectal cancer, J-pouch (or J-pouch) and those randomized from selected reports. The data on bowel function and physiological function of the anal canal and (neo) rectum were meta-analyzed using fixed effect model and random effect model.</p><p><b>RESULTS</b>Eight randomized trails including 378 patients entered this study. After one year follow-up, the functional results showed that there were significant differences in stool frequency per day, urgency and use of medication between colonic J-pouch group and straight coloanal anastomosis group. On physiological function of the anal canal and (neo) rectum, there was significant difference only in rectal compliance between the two groups. But there was no significant difference in other 4 items.</p><p><b>CONCLUSIONS</b>The functional improvement gained from colonic J-pouch coloanal anastomosis continues to benefit the patient with mid or low rectal cancer for at least 12 months. It is necessary to further study about the effect of colonic J-pouch coloanal anastomosis on physiological function of the anal canal and (neo) rectum.</p>

Umbilical metastases of intra-abdominal malignancies / 中国普通外科杂志

Objective To study the clinical pathological features,treatment and prognosis of umbilical metastases of intra abdominal malignancies (sister Mary Joseph nodule, SMJN). Methods From January 1980 to July 2003, 17 SMJN cases were admitted. The clinical features were reviewed. Results The diagnosis of SMJN was confirmed by pathology in all cases, including epithelial ovarian carcinoma in 6 cases, gastric adenocarcinoma in 6 cases,colon adenocarcinoma in 2 cases, and endometrial carcinoma, gallbladder carcinoma and undifferentiated adenocarcinoma without identifying primary site in one each. Mean survival、half year、one year and two year survival rate in 10 palliative excision cases was 13 5 months、60%、20% and 10%, which were significantly better than 8 25 months、14 3%、0% and 0% in 7 conservative therapy cases ( P

Clinicopathologic characters and lymphatic metastasis of cancers at the gastroesophageal junction / 中国普通外科杂志

Objective To summarize the clinicopathologic characters and the route of lymphatic metastasis of cancers at the gastroesophageal junction. Methods Clinicopathologic data of 86 cancer patients treated from October 2000 to December 2004 were analyzed retrospectively. Results There were 66 males and 20 females, the mean age was 60 years. Most patients were of Bormann typeⅢadenocarcinoma. The incidence of high differentiated adenocarcinoma in TypeⅠcancer was higher than that in other two types (P = 0. 002, P = 0. 004) , while the incidence of poor differentiated carcinoma in typeⅢcancer was higher than other two types(P = 0. 005 ,P = 0. 015). Metastatic rate of lymph nodes in group 1 and group 2(34. 9% ) .group 3 and group 4(36. 0% ), group 7 through to group 9(27. 9% ), group 10 and 11 (15. 1% ) was higher than in other groups, while that in group 5 and 6(11. 6% ) , and group 12(5. 8% ) was lower compared with other lymph nodes (P