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Objective@#To compare the clinical efficacy of proximal gastrectomy with double tract reconstruction (PG-DT) and total gastrectomy with Roux-en-Y reconstruction (TG-RY) for proximal gastric cancer.@*Methods@#The retrospective study was conducted. Clinicopathological data of 132 patients with proximal gastric cancer confirmed by pathology who underwent PG-DT (n=51) or TG-RY (n=81) by the same surgeon team in Southwest Hospital of Army Military Medical University between January 2006 and December 2016 were collected. Patients with preoperative neoadjuvant therapy, non-R0 resection and non-adenocarcinoma confirmed by pathology were excluded. Observation indicators included intraoperative (operation time and blood loss); postoperative (time to flatus, hospital stay, total complications, metastasis of lymph nodes around distal side of stomach from cases undergoing TG-RY), follow-up (long-term hemoglobin level, incidence of anemia, and survival) parameters. Survival analysis was conducted using the Kaplan-Meier method, and Log-rank test was used to compare survival difference between two groups.@*Results@#No statistically significant differences were found between two groups in the baseline data, including age, gender, BMI, hemoglobin level before operation, postoperative TNM stage, tumor size and histological differentiation between two groups (all P>0.05). There were no significant differences between PG-DT and TG-RY in intraoperative blood loss [200 (200) ml vs. 200 (195) ml, Z=-1.860, P=0.063], time to flatus [(2.7±1.0) days vs. (2.6±1.1) days, t=0.225, P=0.823], postoperative hospital stay [10(3) days vs. 10 (4) days, Z=-0.449, P=0.654] and morbidity of perioperative complications [5.9% (3/51) vs. 8.6% (7/81), χ2=0.081, P=0.775]. Compared with the TG-RY group, PG-DT group had longer total operative time [294 (97) minutes vs. 255 (71) minutes, Z=–3.148, P=0.002]. The hemoglobin data of 42 patients with PG-DT and 56 patients with TG-RY were collected 1 year after operation. The incidence of anemia in PG-DT group was lower than that of TG-RY group [64.2%(27/42) vs. 82.1% (46/56), χ2=4.072, P=0.045], and PG-DT group had higher level of hemoglobin than TG-RY group [(114.4±16.3) g/L vs. (106.6±15.0) g/L, t=2.435, P=0.017]. There were 4 cases (4/81, 4.9%) with metastasis of lymph nodes around distal side of stomach in TG-RY group. All of these 4 tumors were T4 in depth and were more than 5 cm in diameter. The median follow-up period was 26 (1 to 110) months. One-year, 3-year and 5-year survival rates were 93.2%, 65.3% and 55.0% in PG-DT group, and 85.8%, 63.8% and 47.2% in TG-RY group, respectively without significant difference (χ2=0.890, P=0.345).@*Conclusions@#Compared with TG-RY, PG-DT has the same safety and feasibility for proximal gastric cancer. Although the operative time is a little longer than TG-RY, PG-DT has advantages in improving the postoperative hemoglobin level.
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Objective To investigate the prognosis and recurrent factors of primary retroperitoneal liposarcoma (PRPLS).Methods The retrospective case-control study was conducted.The clinicopathological data of 51 patients with PRPLS who were admitted to the Southwest Hospital of the Third Military Medical University from January 2005 and March 2015 were collected.Observation indicators:(1) follow-up institution.(2) Analysis of prognostic factors:gender,age,tumor diameter,combined organs resection,pathological type,cancer risk and local recurrence.(3) Analysis of recurrent risk factors:gender,age,tumor diameter,combined organs resection,pathological type and cancer risk.(4) Stratified analysis:the independent risk factors of recurrence were done by the stratified analysis.(5) Correlation between cancer risk and tumor diameter or number of organs invaded.(6) Correlation between adjacent organ invasion and tumor diameter.Follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence up to October 2015.The survival rate and curve were respectively calculated and drawn by KaplanMeier method.The univariate analysis and survival analysis were done using the Log-rank test.The multivariate analysis was done by the COX regression model.The correlation analysis was done using the Pearson test.Results (1) Follow-up institution:51 patients were followed up for 3-114 months,with a median time of 43 months.The 3-year survival rate of 51 patients was 70.6％.Twenty-two patients had the first local recurrence,with a recurrent time of 3-60 months and a median time of 29 months.(2)Analysis of prognostic factors:the results of univariate analysis showed that tumor diameter,combined organs resection,pathological type,cancer risk and local recurrence were the related factors affecting prognosis of patients with PRPLS (x2 =5.926,4.936,17.856,17.279,14.568,P ＜ 0.05).The results of multivariate analysis showed that combined organs resection,pathological type and cancer risk were the independent factors affecting prognosis of patients with PRPLS [OR =0.538,0.645,9.620,95％ confidence interval (CI):0.238-0.997,0.458-1.058,1.692-18.714,P ＜ 0.05].(3) Analysis of recurrent risk factors:the results of univariate analysis showed that pathological type and cancer risk were the related factors affecting recurrence of patients with PRPLS (x2 =12.375,12.364,P ＜ 0.05).The results of multivariate analysis showed that cancer risk was an independent factor affecting recurrence of patients with PRPLS (OR =6.234,95％ CI:1.419-27.377,P ＜ 0.05).(4) Stratified analysis:the 3-year survival rates of 11 patients with low risk of recurrence of PRPLS and with high risk of recurrence of PRPLS were 63.6％ and 9.1％,respectively,with a statistically significant difference (x2 =12.364,P ＜ 0.05).(5)Correlation between cancer risk and tumor diameter or number of organs invaded.Tumor diameter and number of organs invaded were respectively (17 ±8)cm,1 ± 1 in 33 patients with low risk of PRPLS and (19 ±5)cm,2 ± 1 in 18 patients with high risk of PRPLS,with no statistically significant difference in tumor diameter (r =0.222,P ＞ 0.05) and with a statistically significant difference in number of organs invaded (r =0.666,P ＜ 0.05).(6)Correlation between adjacent organ invasion and tumor diameter.Tumor diameter was (16 ± 8) cm in 19 patients without adjacent organ invasion and (19 ± 7)cm in 32 patients with adjacent organ invasion,respectively,showing no statistically significant difference (r =0.225,P ＞ 0.05).Conclusions The combined organs resection,pathological type and cancer risk are independent factors affecting prognosis of patients with PRPLS,and cancer risk is an independent factor affecting recurrence of patients with PRPLS.The prognosis of patients with low risk of PRPLS is better than that with high risk of PRPLS.The organ invaded is much likely to occur in patients with high risk of PRPLS.
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<p><b>OBJECTIVE</b>To compare the efficacy between laparoscopic and open surgery in the treatment of gastric gastrointestinal stromal tumor (gastric GIST), and to explore the feasibility and safety of laparoscopic resection for gastric GIST.</p><p><b>METHODS</b>Clinical data of 226 gastric GIST patients confirmed by pathology with maximal tumor diameter less than 10 cm undergoing operation in our department from January 2002 to December 2013 were retrospectively analyzed. Among them, 158 patients received laparoscopic surgery(laparoscopic group), and 68 open surgery (open group). Related indicators of clinical efficacy were compared between the two groups. Laparoscopic group patients were further divided into 4 groups according to chronological order, including 39 patients in group A, 39 in group B, 39 in group C and 41 in group D. Operating time was compared among 4 groups.</p><p><b>RESULTS</b>Compared with the open group, laparoscopic group had shorter operation time [(138.8±69.2) min vs. (173.3±74.5) min, P=0.001], less intraoperative bleeding [30 ml vs. 125 ml, P=0.000], faster recovery to postoperative first flatus [(3.2±1.1) d vs. (3.8±1.1) d, P=0.000] and resumption of oral intake [(3.9±1.5) d vs. (4.7±1.5) d, P=0.000], and a shorter hospital stay [(8.1±2.3) d vs. (10.0±2.6) d, P=0.001]. The operation time of laparoscopic group A, B, C and D was (181.0±81.2) min, (124.7±57.8) min, (126.9±67.9) min and (123.4±51.8) min respectively, and the difference was statistically significant(F=7.188, P=0.001). Median follow-up time of 226 patients was 32 months(5 to 104 months). In laparoscopic group, 136 cases(86.1%) received follow-up, and the 1-, 3-, and 5-year overall survival were 98.7%, 90.7% and 72.8% respectively. In the open group, 59 cases (86.8%) received follow-up, and the 1-, 3-, and 5-year overall survival were 98.3%, 87.1% and 83.1%, respectively. The survival between two groups were not significantly different(P=0.164).</p><p><b>CONCLUSIONS</b>Laparoscopic surgery removing gastric GIST with a maximal diameter of less than 10 cm is safe and feasible. The learning curve of laparoscopic gastric GIST surgery is about 40 cases.</p>