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This paper is about the clinical trials of preoperative concurrent chemoradiotherapy for advanced adenocarcinoma of the stomach or gastroesophageal junction reported in recent years. The radiation dose of most trials is 45 Gy. Chemotherapy drugs such as 5-fluorouracil, cisplatin and taxol are concurrently used as sensitizers. A number of trials have induction chemotherapy prior to chemoradiotherpy. The validity is evaluated by R0 resection rate, pathological complete response rate and overall survival rate. The safety is assessed by the adverse reaction, treatment related mortality, and its effect on postoperative complications and mortality. The results showed that preoperative chemoradiotherapy can significantly improve the R0 resection rate and benefit the prognosis of the patients. Meanwhile, the security and impact on operations of preoperative chemoradiotherapy is controllable. The recent researches are mostly in phase II, and more randomized controlled studies are needed. To fully accept the preoperative chemoradiotherapy as a standard treatment, more evidence and long-term efficacy index are indispensible.
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Objective To study the clinicopathological characteristics of hereditary nonpolyposis colorectal cancer (HNPCC) in Chinese population with different criteria and guidelines. Methods Twenty four families fulfilling Amsterdam Criteria (AC), 15 additional families fulfilling Japanese Criteria (JC) and the remaining 19 patients fitting Bethesda Guidelines (BG) were analyzed. Results In the 24 AC families there were 116 malignant tumor patients including 90 colorectal cancer (CRC) subjects and in the 15 JC families there were 54 malignant tumor patients including 33 CRC cases. The two groups displayed similar clinical features. Mean age of first CRC at diagnosis was 46.1 and 51.4 years old, respectively. The proximal colonic cancers accounted for 55.4% versus 44.8%. Synchronous and metachronous multiple CRCs occurred in 25.6% and 18.2% of patients respectively. Totally there were 55 extracolonic tumors in the two groups. Gastric and endometrial carcinomas were two most common extracolonic tumor types in our series. The tumors of the 34 probands showed more frequent exophytic growth pattern, higher occurance of poorly differentiated carcinoma, A / B Dukes stage and more Crohn's like lymphoid reaction ( P
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Purpose:To study the clinical characteristics of primary colorectal non Hodgkin's lymphoma, analyze the prognostic factors, and assess the results of treatment with adjuvant chemotherapy and radiotherapy. Methods:Ninety four patients were restrospectively studied at our institution between 1971 and 1995, and all of them underwent operation and were confirmed primary colorectal non Hodgkin's lymphoma pathologically. Adjuvant chemotherapy and radiotherapy were administered to 77 and 83 patients respectively. The univariate and multivariate analysis were used to estimate the prognostic factors.Results:The 3 , 5 , and 10 year survival rate was 62.5%, 61.0%, and 58.9% respectively. By univariate analysis, the operation type, lymph node metastasis, postoperative chemotherapy, postoperative radiotherapy, clinical stage were the significant prognostic factors for survival ( P
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Total gastrectomy is a very important mode of therapy for gastric cancer.Many different types of reconstruction have been proposed,but there is no definitive conclusions as to which procedure is the best because of the postoperative complications,such as dumping syndrome,regurgitant esophagitis,malnutrition and so on.In this review,the author summarized recent clinical studies addressing gastrointestinal reconstruction following total gastrectomy.There is still some debate on preserving duodenal passage and the pouch reconstruction can provide improvement of the quality of life in patients receiving total gastrectomy.
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Purpose: To study the clinical treatment and prognosis of gastric cancer in elderly patients. Methods: From 1984 to 1995, 110 old patients with malignant tumor in stomach were treated in this hospital. All 110 patients received surgery with radical resections in 60 cases, palliative resections in 22 cases, laparotomy in 24 cases, and gastrojejunostomy in 4 cases. Results: Postoperative complication was 16. 36%, mortality was 1. 8%. The overall 3- and 5- year survivals for radical resections were 68. 4%, 55. 08%, respectively. Multivariate analyses showed that the favorable factors for prognoses were stage and radical resection. Conclusions: It is recommended that radical resection should be performed for malignant tumors of stomach in old patients. Although the risks of complication morbidity and surgery mortality are more likely to be higher after surgery for the elderly, the outcome would be better if more attention were paid, to improve patients general condition, and correct management after surgery.\;
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PURPOSETo introduce how to reconstruct defects after resection for locally advanced carcinoma of externa-lia in man. METHODS In 11 male patients after radical resection of the primary lesion and clearance of lymph nodes, fascial flap, rectus abdominis myocutaneous flap or combined myocutaneous flap of musculus gluteus max-imus and musculus tensor fasciae latae are used to reconstruct the large defects. Reconstruction with rectus abdominis myocutaneous flap is explained in detail. RESULTS In 11 male patients. 10 were healed by first intention, one was healed by granulation. CONCLUSION The key to successful operation is to select the suitable myocutaneous flap according to the degree of defects. Indication and key points of the operation are explained.
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Purpose:To study the clinical and pathologica l features of rectal carcinoid and factors influencing the prognosis.Metho ds:Data of 43 rectal carcinoid patients were analyzed retrospectively.4 2 patients were followed up postoperatively. Primary tumors were classified by s ize and muscularis invasion respectively.Results:The 5-year su rvival rate was 100% for the patients with tumor 2cm. the 5-year survival rate was 100% for the patients without muscularis invasion, and 50% for those with muscularis invasion.Conclusions:Tumor size and muscularis invasion are important pr ognostic factors for rectal carcinold.
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ObjectiveTo assess the diagnostic value of preoperative lymphoscintigraphy for lateral lymph node metastasis in low rectal cancer. MethodsFrom May 1999 to March 2001, pelvic and lower abdominal lymphoscintigraphy with 99mTc sulfur colloid was performed on 32 patients with proven colorectal cancer one day prior to operation. Among these patients were 27 rectal cancers, 3 sigmoid cancers and 2 colon cancers. Fifteen cases of rectal cancer with the tumor located at or below the peritoneal reflection received extended lymphadenectomy with lateral dissection (D3 lymphadenectomy). The result of lymphoscintigrams was correlated with histologic lateral node examination. Results The image ratio of pararectal nodes, obturator nodes, and internal iliac aorti lymph trains was 69%, 91%, and 100% respectively. In 15 patients receiving D3 lymphadenectomy, 10 had negative lymphoscintigrams whereas 5 had positive image, and the lateral pathology positive rate was 13%(2/15). Analysis of these results revealed the sensitivity (100%), specificity (77%) and accuracy (80%) of this diagnostic method. ConclusionPelvic and lower abdominal lymphoscintigraphy with 99mTc sulfur colloid could demonstrate the lateral lymph node drainage of low rectal cancer, and the correlation with postoperative histologic lateral node examination was high enough to enable surgeons to adopt an individualized surgical approach.