ABSTRACT
Objective To evaluate the clinical efficacy of total mesoesophageal excision and sanye lymph node dissection in the radical resection of esophageal carcinoma under thoracoscopy and laparoscopy,and to investigate its safety and feasibility, and to find a more reasonable and effective surgical treatment of esophageal carcinoma. Methods One hundred and twenty-six cases of esophageal cancer who underwent the minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer in Central Hospital of Hengyang from October 2015 to September 2017 were retrospectively analyzed. Among them,Sixty-four patients accepted total mesoesophageal excision and sanye lymph node dissection under thoracoscopy and laparoscopy (observation group ), Sixty-two cases accepted with conventional esophagectomy under thoracoscopy and laparoscopy ( control group) . The operation time, blood loss, indwelling time of thoracic drainage tube, postoperative drainage volume,postoperative hospitalization time,number of lymph node dissection,lymph node metastasis degree,perioperative complications of the two groups were analyzed and compared. The number of lymph node dissection and lymph node metastasis degree in different regions were compared between the two groups. The number of recurrence and death were recorded in the two groups. Results Compared with the control group,the operation time was longer in the observation group((264. 9±32. 9) min vs. (233. 5±30. 4) min,t= -5. 56,P<0. 001),but blood loss was less((152. 7±26. 4) ml vs. (235. 5± 30. 6) ml,t = 16. 27,P<0. 001). There was no significant difference in the indwelling time of thoracic drainage tube, postoperative drainage volume or postoperative hospitalization time between the two groups (P>0. 05). The number of lymph nodes in the observation group was significantly higher than that in the control group ((32. 7±15. 5) pieces vs. (20. 9±11. 2) pieces,t = - 4. 93,P< 0. 001),and lymph node metastasis degree in the observation group was smaller than that of the control group ( 6. 7% vs. 9. 3%, χ2 = 7. 22, P < 0. 01) . There were no significant differences in perioperative complications such as pulmonary complications, arrhythmia, anastomotic fistula, chylothorax,hemorrhage,recurrent laryngeal nerve injury,tracheal injury and perioperative death (P>0. 05). Left and right recurrent laryngeal nerve,thoracic esophagus,celiac artery lymph node dissection of the number of observation group was higher than that of the control group ((4. 7 ± 3. 2) pieces vs. (1. 5 ± 1. 4) pieces, t= -7. 25;(6. 0±2. 7) pieces vs. (3. 1±1. 7) pieces,t = -7. 12;(5. 7± 2. 4) pieces vs. (3. 2± 1. 9) pieces,t= -6. 48;P<0. 001). Left and right recurrent laryngeal nerve,thoracic esophagus lymph node metastasis degree in the observation group was smaller than that in the control group (8. 7%(26/ 300) vs. 18. 1%(17/ 94),χ2= 6. 53;8. 9%(34/ 382) vs. 17. 9%(35/ 195),χ2 = 10. 04;P<0. 05) . There were no significant differences in the recurrence rate of tumor recurrence at 1 and 24 months after operation in the observation group and the control group(3 cases(4. 7%) vs. 4 cases(6. 5%),χ2 = 0. 92,P > 0. 05) . There were no deaths in the two groups. Conclusion Total mesoesophageal excision and three-field lymph node dissection in radical resection of esophageal carcinoma under thoracoscopy and laparoscopy is safe and feasible,the recent effect does not increase the surgical complications, but its long-term effect need a lot of long-term follow-up. A relatively thorough cleaning of the esophageal mesentery and its lymph nodes can minimize the tumor in the subendothelial micrometastasis,and is beneficial for the prognosis of patients with esophageal cancer.
ABSTRACT
Objective To analyze the feasibility and clinical effect of thoracoscopy and laparoscopy minimally invasive surgery in the treatment of esophageal cancer.Methods Eighty-six cases patients with esophageal cancer who were underwent the minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer in the Central Hospital of Hengyang from August 2014 to February 2016 were retrospectively analyzed.Operation time,bleeding volume,indwelling time of thoracic drainage tube,length of stay,number of lymph node dissection,postoperative complications and so on were recorded.Results All patients were successfully completed surgery,no intraoperative death and intraoperative massive hemorrhage.Operation time was 270-380 min,the amount of bleeding during the operation was 50-550 ml.Chest drainage tube was removed from 3 to 10 d after operation.The number of lymph node dissected was 10-19.Lymph node metastasis was found in 13 cases.Postoperative cervical anastomotic fistula in 6(7.0%) cases,hoarseness in 8(9.3%) cases,7(8.1%) cases of pulmonary infection,and 1(1.2%) case of chylothorax,all were cured after conservative treatment.Postoperative hospital stay was 9-20 d.The patients were followed up for 3 to 21 months,1 case had lymph node metastasis in 10 months after surgery,and the other patients had no recurrence,metastasis or death.Conclusion Minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer is safe and feasible,clinical effect is satisfied,it is worthy of further clinical application.
ABSTRACT
In order to investigate the effects of vector-based hairpin small interference RNA (shRNA) on the reversal of multi-drug resistance (mdr) of A2780/Taxol cells, a novel vector pEGFP-H1/mdr1 containing mdr1-shRNA targeting at position 2943-2963 of mdr1 was designed and synthesized. Subsequently, A2780/Taxol cells were transfected with pEGFP-H1/mdr1, and the expression of mdr1 mRNA and P-gp was detected by using RT-PCR and Western blot respectively. MTT was used to measure the 50% inhibition concentration (IC(50)) of Taxol to A2780/Taxol cells. The results showed that at the 24th and 48th h after transfection, the expression of mdr1 mRNA was decreased to (52.1+/-1.0)% and (0.01+/-1.7)%, and that of P-gp decreased to (88.3+/-2.1)% and 0%, respectively. At the 48th h after transfection, the relative reversal rate of A2780/Taxol cells to Taxol was 69.54%. In vivo, the nude mice xenografts were injected with pEGFP-H1/mdr1, and then administrated Taxol. The tumor volume in pEGFP-H1/mdr1-transfected group was significantly reduced as compared with that in blank control group or pEGFP-H1-transfected group (807.20+/-103.16 vs 1563.78+/-210.54 or 1480.78+/-241.24 mm(3), both P<0.01). These results suggested that transfection of pEGFP-H1/mdr1 could efficiently down-regulate the expression of mdr1 mRNA and P-gp in A2780/Taxol cells, and effectively restore the sensitivity of A2780/Taxol cells to Taxol both in vitro and in vivo.