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Objective To investigate the safety and feasibility of laparoscopy-assisted radical gastrectomy in elderly gastric cancer patients aged over 70 years.Methods Clinical data of 222 elderly gastric cancer patients aged over 70 years receiving surgery from January 2010 to January 2015 were retrospectively analyzed.Patients were divided into the laparoscopy-assisted radical gastrectomy group (LAG group,n=106) and the conventional open gastrectomy group (OG group,n=116),depending on the surgery type.General information,surgical parameters,intra-operative blood pressure fluctuations & blood gas analysis,postoperative recovery and complication rates were compared between the two groups.Results There were no significant differences between the two groups in gender,age,preoperative coexisting diseases,tumor size and location,TNM staging or extent of resection (all P＞0.05).Compared with the OG group,blood loss (86.9±38.9) ml vs.(168.8±49.1) ml,t=10.923,P＜0.01),operative incision length [(9.20±1.55) cm vs.(16.50± 2.12) cm,t=8.788,P＜0.01],time to bowel function recovery [(3.20±1.09) d vs.(5.50±1.16) d,t=4.590,P＜0.01],hospital stay [(11.82±3.92) d vs.(16.14±4.69) d,t=2.234,P＜0.05] and postoperative complications (12.3％ vs.26.4％,x2 =5.186,P＜0.05) were reduced in the LAG group.The LAG group had higher levels of partial pressure of carbon dioxide in arterial blood (PaCO2) and lower levels of base excess than the OG group [(48.10±5.53) mmHg vs.(40.25± 4.66) mmHg,(-7.45±3.72) mmol/L vs.(-3.35±1.98) mmol/L,t=6.908 and 3.619,P＜ 0.01 and 0.05].However,there were no significant differences between the two groups in partial pressure of oxygen (PaO2),arterial oxygen saturation (SaO2) or hydrogen ion concentration (all P＞ 0.05).No significant differences in operation time or number of retrieved lymph nodes were found between the two groups [(196.1 ± 23.4) min vs.(184.2 ± 26.9) min,(28.7 ± 6.5) vs.(27.3 ± 5.6),t=1.174 and 0.515,both P＞0.05].Conclusions Laparoscopy-assisted radical gastrectomy is safe and practical in elderly patients aged over 70 years with gastric cancer and can achieve comparable effects of open radical gastrectomy with less invasiveness and faster recovery.
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<p><b>OBJECTIVE</b>To evaluate the advantage and short-term efficacy of three-dimensional (3D) laparoscopic-assisted D2 radical gastrectomy for gastric cancer.</p><p><b>METHODS</b>Clinical data of 116 gastric cancer patients who underwent laparoscopic-assisted D2 radical gastrectomy in our department from January 2014 to August 2015 were analyzed retrospectively. Among 116 patients, 56 received 3D and 60 received two-dimensional(2D) technique respectively. All the surgeries were performed by the same team. The operative parameters, short-term efficacy and hospital expense were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences between the two groups in baseline data(all P>0.05). All the operations were performed successfully without conversion. Compared with 2D group, 3D group had shorter operative time [(186.2±22.8) minutes vs. (198.1±26.4) minutes, t=2.589, P=0.011], less intraoperative blood loss [(73.6±28.5) ml vs. (88.1±32.3)ml, t=2.555, P=0.012]. Whereas no significant differences in dissected lymph nodes(36.5±6.6 vs. 34.5±5.4, P=0.073), time to first flatus[(3.1±1.5) days vs. (3.3±1.8) days, P=0.729], length of hospital stay[(11.7±2.9) days vs. (12.6±3.1) days, P=0.088], incidence of postoperative complications [8.9%(5/56) vs. 11.7%(7/60), P=0.628] and hospitalization cost [(8.6±1.4)×10(4) yuan vs. (8.1±1.2)×10(4) yuan, P=0.055] were found between two groups.</p><p><b>CONCLUSION</b>Three-dimensional laparoscopic-assisted D2 radical gastrectomy may be advantageous over two-dimensional laparoscopic-assisted D2 radical gastrectomy.</p>
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Humans , Blood Loss, Surgical , Gastrectomy , Methods , Laparoscopy , Length of Stay , Lymph Node Excision , Operative Time , Postoperative Complications , Retrospective Studies , Stomach Neoplasms , General Surgery , Treatment OutcomeABSTRACT
Objective: To explore the therapeutic effects of sequential chemoradiotherapy with pemetrexed and cisplatin on locally advanced laryngeal cancer [LALC]
Methods:Fifty LALC patients who were treated in our hospital between January 2010 and January 2012 were selected and randomly divided into an observation group and a control group [n=25]. The two groups were given conventional radiotherapy in the same manner, before which two cycles of chemotherapy were performed. The observation group intravenously infused with 500 mg/m[2] pemetrexed on d1 and 25 mg/ m[2] cisplatin on d1-3, with 28 days as a cycle. The control group was intravenously infused with 25 mg/m[2] cisplatin on d1-3 and 400 mg/m[2] fluorouracil, with 28 days as a cycle. The short-term effects and adverse reactions of both groups were observed after treatment, and their survival was observed by follow-up for five years
Results:The response rate was 84% [21/25] in the observation group and 64% [16/25] in the control group, between which the difference was statistically significant [P<0.05]. The differences in the incidence rates of short-term adverse reactions such as grade III-IV gastrointestinal reactions and bone marrow suppression were not statistically significant between PC regimen [pemetrexed combined with cisplatin] and PF regimen [cisplatin combined with fluorouracil] [P>0.05]. The incidence of long-term adverse reactions such as grade III-IV laryngeal edemas, laryngeal cartilage inflammation and laryngeal cartilage necrosis showed no significant differences between the two groups [P>0.05]. The median survival was 3.3 years after PC chemotherapy and 2.8 years after PF chemotherapy, between which the difference was not statistically significant [P>0.05]. The levels of serum tumor markers significantly decreased after PC and PF treatments compared with those before [P<0.05]
Conclusion:Combining PC chemotherapy with radiotherapy has satisfactory short-term therapeutic effects on LALC, and the resulting adverse effects can be tolerated. Therefore, this strategy is worthy of promotion and application in clinical practice
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Objective To explore the effectiveness and safety of totally laparoscopic distal gastrectomy (TLDG)and laparoscopically assisted distal gastrectomy (LADG)for gastric cancer.Methods The comparative studies of TLDG and LADG published between 2008 and 2014 were searched from PubMed,EMBASE,Chinese Biomedical Literature Database (CBM),China National Knowledge Infrastructure (CNKI). After screening for inclusion, data extraction,and quality assessment,RevMan 5.3 software was used for Meta-analysis.Results Ten studies of 2 212 patients were included in the Meta-analysis,among whom 930 cases underwent TLDG and 1 282 cases underwent LADG.The results of Meta-analysis indicated that compared with LADG,TLDG had the advantages of less blood loss (WMD= - 20.70,95%CI:- 30.81 - - 10.59,P <0.01),less usage of analgesic (WMD=-0.38,95%CI:-0.74 - -0.02,P =0.04),more retrieved lymph nodes (WMD= 2.98,95%CI:0.71 -5.26,P =0.01).However,the Meta-analysis showed no statistically significant differences in the operation time, postoperative time-to-first flatus and oral intake,postoperative hospital stay,length of proximal resection margin, C reaction protein (CRP)level at postoperative day 1,incidence of overall complications and anastomosis-related complications.Conclusion TLDG is safe and effective with less blood loss, less pain than those of LADG. Moreover,it has comparable results to conventional LADG,with no increase of postoperative complications.