Risk factors associated with postoperative hospital stay after pancreaticoduodenectomy: a retrospective study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Postoperative hospital stay after pancreaticoduodenectomy (PD) is relatively longer than after other gastrointestinal operations. The aim of the current study was to investigate the risk factors associated with prolonged hospital stay after PD.</p><p><b>METHODS</b>Patients who had PD at the Cancer Hospital of Chinese Academy of Medical Sciences between December 2008 and November 2012 were selected for this retrospective study. Clinical and pathological data were collected and analyzed. The primary outcome was postoperative length of stay. Normal discharge or recovery was defined as a postoperative hospital stay of no more than 10 days; otherwise it was defined as delayed discharge or recovery (including hospital death).</p><p><b>RESULTS</b>A total of 152 patients were enrolled in the present study. Postoperative hospital stay was (19.7 ± 7.7) days (range 7-57). Of the 152 patients, 67 were discharged within the normal time and 85 had delayed discharge. Postoperative complications occurred in 62.5% (95/152), and the mortality rate was 3.29% (5/152). Multiple regression analysis showed that delayed discharge was significantly associated with postoperative complications (adjusted odds ratio (OR) 10.40, 95% confidence interval (CI) 3.58-30.22), age (adjusted OR 4.09, 95% CI 1.16-14.39), body mass index (BMI) (adjusted OR 4.40, 95% CI 1.19-16.23), surgical procedure (adjusted OR 26.14, 95% CI 4.94-153.19), blood transfusion (adjusted OR 7.68, 95% CI 2.09-28.27), and fluid input (adjusted OR 3.47, 95% CI 1.24-11.57).</p><p><b>CONCLUSIONS</b>Postoperative complications increase the time to postoperative hospital discharge. The length of hospital stay after PD is also associated with age, BMI, blood transfusion, surgical procedure, and fluid input. Further studies with more patients are needed in future.</p>

A diagnostic meta-analysis: sentinel lymph node biopsy for neck metastasis in patients with early oral squamous cell carcinoma / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the value of sentinel lymph node biopsy in diagnosis of cervical metastasis in patients with early oral squamous cell carcinoma.</p><p><b>METHODS</b>Cochrane library, evidence-based medicine (EBM), PubMed, China national knowledge internet (CNKI) were searched for 2001 - 2011 literatures on sentinel lymph node biopsy in patients with oral squamous cell carcinoma as early diagnosis of cervical metastasis. The results were analysed by using Meta-analysis software Metadisc1.4.</p><p><b>RESULTS</b>There were 12 studies in which, a total of 793 patients with oral squamous cell carcinoma were involved in Meta-analysis. The combined sensitivity and specificity were 0.86 (95%CI: 0.81 - 0.90) and 0.99 (95%CI: 0.98 - 1.00) respectively.</p><p><b>CONCLUSIONS</b>For early oral cancer patients, the sensitivity and specificity of sentinel lymph node biopsy are relatively high. The sentinel lymph node biopsy could be used to select which patients need neck dissection.</p>

Surgical management of complicated orbital fractures: experiences with 89 orbital corrections and reconstructions / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To summarize the experiences in the treatment of complicated orbital fractures.</p><p><b>METHODS</b>A total of 89 patients with complicated orbital fractures treated in Department of Oral and Maxillofacial Surgery, China Medical University from January 2005 to January 2010 were retrospectively reviewed. The classification of these cases included naso-orbital-ethmoid fracture, frontal orbital fracture and orbitozygomatic fracture. All patients were followed up for 6 - 36 months.</p><p><b>RESULTS</b>The orbital frame was repaired or reconstructed in these patients. The function of lacrimal pathways was improved. All the patients and the physicians were satisfied with the surgical effects. However, recurrence of deformity after endophthalmas correction was found in several cases.</p><p><b>CONCLUSIONS</b>The experiences, comprehensive management of complicated orbital fractures by team approaches, concluded from this study could be expanded. There are still challenges in the treatment of complicated orbital fractures, such as severe endophthalmas deformity, recurrence of endophthalmas deformity and malunion of complicated orbital fracture.</p>

The role of slow-release 5-fluorouracil implantation in treatment of unresectable pancreatic cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the role of slow-release 5-fluorouracil implantation in treatment of unresectable pancreatic cancer.</p><p><b>METHODS</b>85 cases of untreated patients with locally advanced pancreatic cancer (LAPC) were randomized into two groups: Trial group: slow-release 5-fluorouracil implantation (50 patients) and control group (35 patients). Observing the objective tumor response, clinical benefit response, toxicity, complications and survival of patients of the two groups.</p><p><b>RESULTS</b>In the trial group the overall response rate (PR + NC) was 76.0%, and the clinical benefit response rate was 52.0%. No toxicity was observed. Pancreatic fistula occurred in 2 patients. The median survival time of the two groups was 9.0 months and 4.0 months, respectively. The survival rates of 6- and 12-month were 56.8% vs. 31.4% and 22.9% vs. 2.9% in the two groups, respectively (P = 0.012).</p><p><b>CONCLUSION</b>Slow-release 5-fluorouracil implantation is a simple, safe and effective method in treatment of LAPC.</p>

Analysis of risk factors of stress-related ulcer and gastrointestinal hemorrhage after pancreaticoduodenectomy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To assess the risk factors of stress-related ulcer and gastrointestinal hemorrhage after pancreaticoduodenectomy.</p><p><b>METHODS</b>From May 1999 to July 2007, 285 periampullary cancer patients underwent pancreaticoduodenectomy in our hospital. The clinical data, pathological results, type of operation, and postoperative treatment were retrospectively analyzed. Patients with stress-related ulcer and gastrointestinal hemorrhage were selected for risk factor analysis, and other patients were taken as control group.</p><p><b>RESULTS</b>35 patients (12.3%) developed stress-related ulcer and gastrointestinal hemorrhage following pancreaticoduodenectomy. Pathological examination showed pancreatic cancer in 5 cases, duodenal cancer in 8, common bile duct cancer in 10, ampullary carcinoma in 11, and solid-pseudopapillary tumors in 1. Single variate analysis demonstrated that alcohol, preoperative bilirubin level, operation time, lymph node metastasis, prealbumin decrease after operation and other complication were significantly associated with the stress-related ulcer and gastrointestinal hemorrhage. Logistic regression in multivariate analysis revealed that preoperative bilirubin level, operation time, other complication, prealbumin decrease after surgery were independent risk factors.</p><p><b>CONCLUSION</b>Stress-related ulcer and gastrointestinal hemorrhage are one of the most common complications after pancreaticoduodenectomy. Preoperative bilirubin level, operation time, other complications, and prealbumin decrease after operation are four independently risk factors.</p>

Classification and surgical management of secondary nasal deformity of unilateral cleft lip / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the classification of alar base depression, so as to provide the reference for the surgical management of secondary nasal deformity of unilateral cleft lip.</p><p><b>METHODS</b>From Jul. 2008 to Feb. 2009, 26 cases with secondary deformity of unilateral cleft lip were treated. All the patients underwent 3-dimensional CT for maxillary measurement. The nasal soft tissue measurement was performed pre- and post-operatively. The relationship between the maxillary and soft tissue at alar base was analyzed. The nasal deformity was classified.</p><p><b>RESULTS</b>The location of alar base was not related to the form of piriform aperture, but the bony defect at the alar base was correlated to the patient satisfactory. The nasal deformity was graded as I when the depression at alar base was less than 4.5 mm in depth, as II when it was 4.5-5.0 mm in depth, and as III when it was more than 5 mm in depth. The deformity could be corrected with only soft tissue plasty for grade I, with soft tissue plasty or artificial implants for grade II, with combined bone autograft or alveolar cleft repair for grade III.</p><p><b>CONCLUSIONS</b>The depression at maxillary does not necessarily result in alar base depression. The alar base can be adjust to proper position through operation. The operation should be designed based on the preoperative nasal measurement.</p>

Application of tru-cut biopsy combined with fine needle aspiration biopsy in the intraoperative pathological diagnosis of pancreatic carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the method and value of tru-cut biopsy (TCB) combined with fine needle aspiration biopsy (FNAB) in the pathological diagnosis of pancreatic carcinoma during operation.</p><p><b>METHODS</b>From April 2007 to October 2008, 22 cases who were suspected to suffer from pancreatic carcinoma were enrolled into this prospective study. All of them underwent a tru-cut biopsy combined with fine needle aspiration biopsy for the pathological diagnosis during operation.</p><p><b>RESULTS</b>Of the 22 patients, 20 were finally diagnosed as having pancreatic carcinoma, while 2 having pancreatitis. The diagnosis of pancreatic carcinoma was confirmed in 19 by tru-cut biopsy combined with fine needle aspiration biopsy, while other 3 cases were not confirmed as pancreatic carcinoma. Among those 3 cases, one was diagnosed as having pancreatic carcinoma with hepatic metastasis by liver nodular biopsy, one as suffering from autoimmune pancreatitis, and another case as having chronic pancreatitis confirmed by follow-up for 9 months without any changes after the operation. The accuracy of FNA, TCB and FNA combined with TCB in the diagnosis for suspected pancreatic cancer were 86.4%, 90.9%, and 95.5%, respectively. No pancreatic fistula and bleeding developed after operation.</p><p><b>CONCLUSION</b>Tru-cut biopsy is more accurate in diagnosis for the suspected pancreatic cancer than fine needle aspiration biopsy during operation. Tru-cut biopsy combined with fine needle aspiration biopsy can improve the accuracy of diagnosis, and is a safe and effective diagnostic method.</p>

Prognostic factors of colorectal cancer patients with synchronous liver metastasis treated with simultaneous liver and colorectal resection / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the prognostic factors of colorectal cancer patients with synchronous liver metastasis treated by simultaneous colorectal and liver resection.</p><p><b>METHODS</b>The clinical and follow-up data of 44 colorectal cancer patients with synchronous liver metastases who underwent simultaneous colorectal and liver resection from Jan. 1993 to Jan. 2003 were analyzed retrospectively. Survival rate was estimated by Kaplan-Meier method, and was compared using log-rank test. Prognostic factors were analyzed by multivariate Cox proportional hazards model.</p><p><b>RESULTS</b>The overall 1-, 3- and 5-year survival rates were 86.3%, 40.9% and 25.0%, respectively. The lymph node metastasis and vascular invasion by cancer cells from the primary tumour were found to affect prognosis significantly, while gender, age, tumor location, histopathological types, the number and distribution of liver metastases were not. Multivariate analysis revealed that the lymph node metastasis was the only independent prognostic factor.</p><p><b>CONCLUSION</b>Simultaneous liver and colorectal resection can be performed and may achieve good outcome in colorectal cancer patients with synchronous liver metastases, especially in those without lymph node metastasis.</p>

Clinicopathological features and prognosis of different gastric carcinoid subtypes / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the clinicopathological features and their relation to treatment and prognosis in different gastric carcinoid subtypes.</p><p><b>METHODS</b>The data of surgically treated 39 patients with gastric carcinoids (9 of type I and 30 of type III) were retrospectively analyzed. Univariate and multivariate analysis were performed using Chi square test (chi(2)) and Cox model, respectively. The survival rates were analyzed by Kaplan-Meier method, and the factors affecting survival by Log rank test.</p><p><b>RESULTS</b>Of the 9 patients with type I carcinoids, 5 underwent endoscopic or surgical resection, and extra antrectomy was performed in 2 patients simultaneously. 3 cases had a proximal gastrectomy, and 1 underwent total gastrectomy. Among the 30 patients with type III gastric carcinoids, 21 underwent radical resection, 6 had a palliative resection, and the remaining 3 underwent exploration and biopsy only due to invasion into adjacent organs and distant metastasis. Infiltration beyond the submucosa was found in all 30 type III gastric carcinoid patients, but in only 1 of 9 patients with type I gastric carcinoids. Regional lymph node metastases were found in 27 of 30 type III carcinoid cases, but in none of type I. Distant metastases occurred in 5 patients of type III carcinoid (4 in the liver and 1 in the ovary). There were statistically significant differences between type I and type III carcinoids in the sex, tumor number, location, size and infiltration depth of the tumors, the regional lymph node metastasis, distant metastasis and lymphatic emboli (P < 0.05 in all). The overall 5-year survival rate was 49.7% for the whole group, and 100.0% and 37.2% for type I and type III carcinoids, respectively. Univariate analysis revealed that the number of tumor, tumor size (> 2 cm), serosal invasion, regional lymph node metastasis and distant metastasis were all significant factors affecting the survival (P < 0.05 in all). However, by multivariate analysis, only distant metastasis was found to be a significant prognostic predictor.</p><p><b>CONCLUSION</b>The prognosis of type III carcinoids is much poorer than that of type I. Subtyping of gastric carcinoids is helpful in guiding clinical management, and also in prediction of malignant potential and prognosis.</p>

Analysis of factors influencing recurrence and metastasis following curative resection of pancreatic ductal adenocarcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the factors influencing recurrence and metastasis following curative resection of pancreatic ductal adenocarcinoma and analyze the prognosis.</p><p><b>METHODS</b>The clinicopathological and follow-up data of 56 patients who underwent curative resection for pancreatic ductal adenocarcinoma between Jan. 1997 and Dec. 2006 in this hospital were analyzed retrospectively.</p><p><b>RESULTS</b>The recurrence rate after curative resection was 73.2% (41/56). The recurrence rate after operation at the time of 3 months, half year, 1 year and 2 years was 26.8% (15/56), 51.8% (29/56), 64.3% (36/56) and 69.6% (39/56), respectively. Hepatic metastasis and local recurrence accounted for 36.6% and 31.7% of the cases, respectively. The 3-year accumulated survival of this group was 22.7%. The symptom presenting time, back pain, preoperative level of CA19-9, tumor size, AJCC stage and T stage were correlated with metastasis/recurrence. Univariate analysis revealed that the preoperative level of CA19-9, T stage and the tumor size were prognostic factors. Cox regression analysis revealed that only tumor size was an independent prognostic factor.</p><p><b>CONCLUSION</b>The metastasis or recurrence mostly occurs within 2 years after curative resection, and the liver is the most common site of metastasis. High recurrence rate is the major reason causing the failure of curative resection and short survival time after operation. The symptom presenting time, back pain, preoperative level of CA19-9, tumor size, AJCC stage and T stage are correlated with metastasis/recurrence. The tumor size is an independent prognostic factor.</p>

Expression of annexin I in human pancreatic cancer and the influence of its down-regulation on biology of this cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the expression of annexin in human pancreatic cancer and to elucidate its role in oncogenesis of pancreatic cancer.</p><p><b>METHODS</b>A pancreatic carcinoma cell line Suit-II with high-expression of annexin I gene was adopted. Three subtypes of annexin I -siRNA sequences and a non-related fragment were combined, and the eukaryotic expression vectors bearing siRNA fragments were constructed. Then they were transfected into pancreatic carcinoma cells to knock down the expression of annexin I by RNAi. After knocking down the expression of annexin I , the growth speed, cell cycling, morphological features and apoptosis of pancreatic carcinoma cells were examined by RT-PCR and MTT test.</p><p><b>RESULTS</b>When the expression of annexin I was blocked, the growth speed of pancreatic carcinoma cells was significantly decreased, the morphological features were changed and pronounced apoptosis occurred.</p><p><b>CONCLUSION</b>Annexin I can modulate pancreatic carcinoma cell cycle, promote the cell proliferation, increasingly stimulate the cell growth, and suppress the process of apoptosis in pancreatic carcinoma cells.</p>

Clinical application of localized biopsy on breast microcalcification / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate fine needle localized biopsy under mammography-guiding and skin incision selection by hookwire under ultrasound-guiding for patients with breast microcalcification.</p><p><b>METHODS</b>Breast microcalcification of 178 patients treated from May 2000 to November 2006 were resected after localized with fine needle under X-ray mammography-guiding. Among them, 62 patients received the selection of hookwire under ultrasound-guiding.</p><p><b>RESULTS</b>Breast cancer was detected in 58 patients (32.6%). Among them, 32 (55.1%) cases were carcinoma in situ, 11 (19.0%) intraductal carcinoma with early infiltration, 15 (25.9%) infiltrative ductal carcinoma, and 4 infiltrative ductal carcinoma with lymph node metastasis. The overall 5-year survival rate was 100%. Compared with that in needle guided group, the acceptable rate of cosmetic results was higher in hookwire group (P = 0.022).</p><p><b>CONCLUSIONS</b>For breast microcalcification, mammography guided needle biopsy with ultrasound selected skin incision is an effective and accurate diagnostic method.</p>

Factors affecting the prognosis and selection of local excision for low rectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the factors affecting the result and selection of local excision for low rectal cancer.</p><p><b>METHODS</b>The clinical data of 101 patients with low rectal cancer treated by local excision were retrospectively analyzed. Survival was estimated using the Kaplan-Meier. The factors influencing on the survival were analyzed using univariate (Log rank) and multivariate (Cox model) analysis methods.</p><p><b>RESULTS</b>Of 101 patients in this series, 91 patients underwent transanal excision, 9 had transsacral excision, 1 recieved transvaginal excision. Postopertative complication developed in 6 patients (5.9%). No death occurred within 30 postoperative days. Five T4 patients underwent preoperative radiotherapy, and 34 received postoperative radiotherapy. The overall 5-year survival rate was 91.0% for the whole group, and it was 100%, 92.6%, 77.1%, 83.3% for patients with Tis, T1, T2, and T3/T4 lesion, respectively. The incidence of local recurrence was 15. 8%. Univariate analysis revealed that pathological T stage, tumor size (> 3 cm), lymphovascular invasion, ulcerative lesion, adjuvant radiotherapy and local recurrence were significant factors affecting the survival (P <0.05). However, by multivariate analysis, only tumor size ( > 3 cm) and local recurrence were found to be the significant prognostic predictors.</p><p><b>CONCLUSION</b>The important selection criteria for local excision in the treatment of low rectal cancer may include T1 stage, well or moderate differentiation,tumor size < or = 3 cm, no lymphovascular invasion.</p>

Surgical therapy of tumor of body and tail of pancreas: report of 117 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To explore diagnosis and surgery therapy and factors influencing the prognosis of tumor of body and tail of the pancreas.</p><p><b>METHODS</b>The clinical data of 117 cases of tumor of tail and body of pancreas who underwent operation were analysed.</p><p><b>RESULTS</b>Imaging and tumor marker detection can give exact diagnosis to cases with tumors of body and tail of pancreas. The medial survival time of radical resection, palliative resection and exploratory laparotomy were 18, 8 and 3.5 months.</p><p><b>CONCLUSIONS</b>Atypical signs should be noticed, combined imaging and serum detection can diagnose the cases exactly, radical resection is the unique method for long survival, the diameter of the tumor and degree of infiltration to major vessels and organs is important.</p>

Application of sigmoid coloplasty in super-lower anastomosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the clinical value of sigmoid coloplasty of super-lower anastomosis.</p><p><b>METHODS</b>Thirty-five patients underwent sigmoid coloplasty (treatment group), while 33 patients received straight sigmoidorectostomy (control group). Complication rate and anal function were observed and compared between the two groups.</p><p><b>RESULTS</b>The complication rate was 17.1% and 21.2% in the study group and control group respectively (P> 0.05). Average stool frequency were 2 times (1-5.5 times) a day in the study group and 3.5 times (1-9 times) a day in the control group 12 months after operation (P< 0.01). The fecal continence and self-satisfaction were improved significantly in the study group than that of the control group(P< 0.01, respectively). The postoperative anal function score was 2.57 in the study group and 7.21 in the control group, there was significant difference between the two groups (P< 0.01).</p><p><b>CONCLUSIONS</b>Compared with straight sigmoidorectostomy, sigmoid coloplasty applied in super-lower anastomosis can significantly improve the recovery of anal function without increasing complication rates.</p>