Application status and prospect of biodegradable polymer stents in pancreatobiliary disease / 中华肝胆外科杂志

Endoscopic stent implantation is one of the main methods for the treatment of biliary and pancreatic diseases. At present, the commonly used biliary and pancreatic stents are mainly plastic and metal stents which are still have some deficiencies in clinical applications, and the emergence of the new type of biodegradable polymer materials is expected to achieve the purpose of treatment to overcome these shortcomings. It is a potential hope to break through the bottleneck of endoscopic treatment of choleopancreatic diseases. Previous animal experiments and human clinical studies have preliminarily shown its safety and effectiveness, which can effectively solve some problems of bile and pancreatic duct stenosis and so on. Biodegradable polymer stents have been widely studied, but their clinical application progress is slow and not yet popular, and it has gradually become a research hotspot in recent years . This article discusses the research status and development direction of biodegradable polymer stents in biliary and pancreatic diseases.

Surgical treatment for peritoneal metastasis from gastric cancer / 中华肿瘤杂志

Peritoneal metastasis from gastric cancer is one of the most important causes of death in gastric cancer. Systemic chemotherapy is the main treatment method at present, but limited curative effect has been acquired.With the deepening understanding and exploration of cancer, the combination of systemic chemotherapy and surgical treatment can not only enrich the administration of chemotherapeutic drugs, but also prolong the survival time of patients. These have been confirmed by subgroup analyses in some clinical studies. Surgery is becoming an important treatment strategy for patients with peritoneal metastasis of gastric cancer. We expect that more prospective results will be verified by evidence-based medicine in the future.

Clinicopathological features and prognostic factors in gastric hepatoid adenocarcinoma / 中华普通外科杂志

Objective To investigate the clinicopathological characteristics and prognostic factors of hepatoid adenocarcinoma of the stomach (HAS).Methods From Jan 2006 to Jan 2016,the clinical pathological data of 15 HAS cases in our hospital were analyzed retrospectively.60 TNM stage matched cases of non-HAS gastric cancer served as the control group.The clinical pathology factors and prognosis were compared between the two groups.Results Serum AFP positive HAS patients accounted for 87％.The serum level of AFP in HAS were significantly higher than that in controls (P ＜0.001).HAS was more prone to lymphatic invasion (73％ vs.33％,x2 =7.918,P =0.005) and vascular invasion (40％ vs.10％,x2 =8.036,P =0.005) than control gastric cancer.The immunohistochemistry positive rates of AFP,Glypican3,Hepatocyte and CEA in HAS were 87％,87％,33％,53％ respectively.Liver metastasis (53％ vs.12％,P =0.001) and other distant metastases (53％ vs.15％,P =0.004) were higher in the HAS.HAS median survival time was significantly lower (28.0 months vs.50.7 months,x2 =4.350,P =0.037).Postoperative HAS 1,3 and 5 years survival rates were 80％,33％ and 20％,respectively,significantly worse than 97％,78％ and 33％ in control group (x2 =5.525,17.198,5.472,P =0.019,0.000,0.019 respectively).The independent risk factor influencing the prognosis of HAS included TNM stage,vascular invasion,distant metastasis.Conclusions HAS is often complicated with higher serum AFP and prone to vascular invasion,lymph node metastasis and distant metastasis,hence a poorer prognosis.

Current status of hereditary gastrointestinal neoplasms / 中华胃肠外科杂志

Gastric cancer and colorectal cancer are two common malignant tumors in digestive tract. 1% to 3% of gastric cancer and 5% to 15% of colorectal cancer are definitely hereditary cancer caused by germline gene mutation. Hereditary gastric cancer includes hereditary diffuse gastric cancer(HDGC) and hereditary intestinal gastric cancer (HIGC). CDH1 gene mutation is the main reason to cause HDGC, so the first degree and the second degree family members of HDGC patients are recommended to receive CDH1 mutation detection, endoscopic examination every year and undergo preventive total gastrectomy. Hereditary colorectal cancer includes hereditary nonpolyposis colorectal cancer (HNPCC, or Lynch syndrome) and familial adenomatous polyposis (FAP). Germline MMR gene mutation detection is the golden standard of the diagnosis of Lynch syndrome. Family members of Lynch syndrome patients are recommended to receive endoscopic examination every year and undergo standard cancer radical operation or total colorectal resection based on individual conditions. FAP is caused by APC gene mutation, so FAP patients are recommended to receive endoscopic examination once or twice every year through their lifetime, while a lot of adenoma occur, resection should be considered. The promotion key of hereditary gastrointestinal neoplasms research is to follow the standard diagnosis and treatment guideline for hereditary gastrointestinal neoplasms and build the clinical and gene information bank of hereditary gastrointestinal neoplasms. The second generation sequencing technique provides favorable research stools in elucidating pathogenesis mechanism of hereditary gastrointestinal neoplasms.

The efficacy of laparoscopic-assisted hemicolectomy versus that of open hemicolectomy for right colon carcinoma / 实用医学杂志

Objective To compare the efficacy of laparoscopic-assisted hemicolectomy with that of open hemicolectomy for right colon carcinoma and to explore the safety and effectiveness of the formor procedure. Methods The clinical data on 46 patients who had undergone laparoscopic-assisted hemicolectomy and 68 patients who had received open hemicolectomy between December 2009 and December 2013 in our department were retrospectively analyzed. Length of postoperative hospital stay, surgical duration, amount of intraoperative blood loss, number of lymph node dissection, time to postoperative anal exhaust, surgical costs, postoperative complications, and survival rate were compared between the two groups. Results There were no statistical differences between the two grounps in gender, age, body mass index, pathological typing, depth of invasion, and total number of lymph node dissection. Length of hospital stay was 6.84 days in the group of laparoscopic-assisted hemicolectomy and 11.72 days in the group of open hemicolectomy , with a statistical significance. Surgical duration and treatment costs did not differ significantly between the two groups; while amount of intraoperative blood loss (76.63 mL vs. 141.5 mL) and time to postoperative anal exhaust differed significanly. Conclusions Laparoscopic-assisted hemicolectomy is safe and effective for treatment of colon cancer , It has advantages of small trauma, rapid postoperative recovery, and a nice-looking surgical incision.

Establishment of databases of gastrointestinal cancer based on a comprehensive model / 中华胃肠外科杂志

China has a huge population and the number of patients with gastrointestinal cancer is extremely large. With the development of cancer research, the importance of clinical oncology database has been paid more and more attention. It has been 20 years since the Gastrointestinal Surgery Center of the First Affiliated Hospital of Sun Yat-sen University established the database of gastrointestinal cancer from 1994. In this paper, we summarized the composition, daily operation and the experience of construction of database based on multiple-position in one model in our center. We are expecting more units to spontaneously establish relevant databases and gradually move towards data sharing and thus promote the development of gastrointestinal surgery in China.

Screening for predictive biomarkers of bevacizumab treatment in gastric cancer subcutaneous xenografts / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To establish subcutaneous xenograft models of gastric cancer in nude mice and to screen the predictive biomarkers of bevacizumab effectiveness.</p><p><b>METHODS</b>Subcutaneous xenograft models were established using BGC823 gastric cancer cell line in 20 male 4-week old BALB/C-nu/nu nude mice and were randomly divided into four groups, bevacizumab group(15 mg/kg), 5-FU group(15 mg/kg), combined group and control group, with 5 mice in each group. Bevacizumab and 5-FU were administered intraperitoneally every other day for three weeks. After treatment, tumor size and inhibition rate were calculated. Expression of CD31 was examined by immunohistochemistry for evaluation of microvascular density(MVD). Levels of human vascular endothelial growth factor(VEGF), basic fibroblast growth factor (bFGF), placental growth factor (PIGF) and interleukin 8(IL-8) were tested by enzyme linked immunosorbent assay(ELISA).</p><p><b>RESULTS</b>Compared to the control group, bevacizumab group and combined group had a significantly lower MVD(5.2±1.0 and 4.3±1.2 vs. 13.8±1.6, P<0.05), a smaller tumor volume [(305.6±184.1) mm(3) and (242.2±71.4) mm(3) vs.(1535.2±625.1) mm(3), P<0.05], and lower levels of VEGF and IL-8 in tumor tissues [VEGF:(351.6±84.1) ng/L and (242.2±71.4) ng/L vs. (1256.7±702.1) ng/L, P<0.05); IL-8:(20 903±1485) ng/L and (27 489±6772) ng/L vs. (57 032±2437) ng/L, P<0.05]. The above parameters were not significantly different between 5-FU group and control group(all P>0.05). Levels of bFGF and IGF were not significantly different among four groups as well(all P>0.05).</p><p><b>CONCLUSION</b>VEGF and IL-8 may be used to be biomarkers candidates to predict bevacizumab effectiveness on human gastric cancer.</p>

Clinical management of advanced gastrointestinal stromal tumors after failure of at least both imatinib and sunitinib targeted therapy / 中华胃肠外科杂志

The emergence of small molecular tyrosine kinase inhibitors opened the era of targeted therapy of gastrointestinal stromal tumor(GIST). Survival and life of quality of patients from advanced stage are significantly improved by using targeted therapy. However, with prolonged treatment, drug resistance is becoming more and more common and directly affects the survival of patients. The current clinical management in failure of multi-line targeted therapies will be discussed in this article.

Clinical analysis of 36 cases of duodenal gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To review the clinical features of duodenal gastrointestinal stromal tumors(GISTs), and to compare the clinical efficacy among different surgical treatments for duodenal GISTs.</p><p><b>METHODS</b>Clinicalpathological data of 36 cases of duodenal GISTs undergoing operation in The First Affiliated Hospital of Sun Yat-sen University from January 2000 to July 2013 were retrospectively analyzed. All the patients received surgical treatments, including 15 cases with regional resection, 8 cases with segmental resection, 12 cases with pancreaticoduodenectomy (PD), and 1 case with liver biopsy, respectively. Clinical efficacy between pancreaticoduodenectomy (PD) and non-PD (NPD) was compared.</p><p><b>RESULTS</b>Nine of 36 cases (25%) developed postoperative complications who were all in the PD group. Eight patients recovered and healed finally after active treatment, and 1 case was complicated with acute pancreatitis, pancreatic fistula and intra-abdominal infection. The median follow-up time was 54 months and the 5-year overall survival (OS) rate and 5-year recurrence-free survival (RFS) rate were 78.1% and 72.1%, respectively. The 5-year OS rate in the PD group and the NPD group was 61.1% and 61.1% respectively. The 5-year RFS rate in the PD group and the NPD group was 85.8% and 78.8% respectively. Statistical analysis showed no significant difference between the both groups (P=0.71 and P=0.89).</p><p><b>CONCLUSIONS</b>For duodenal GISTs patients, regional resection and segmental resection have similar clinical outcomes to pancreaticoduodenectomy while the former two can obviously decrease the incidence of postoperative complications. Based on the premise of R0 resection guaranteed, regional sectional and segmental resection with less injury should be the surgical treatment of choice.</p>

Clinicopathologic features and survivals of postoperative gastric carcinoma patients by different tumor locations / 中华普通外科杂志

Objective To summarise the clinicopathologic features and survival of gastric cancer at different tumor locations.Methods A total of 942 adult gastric cancer patients undergoing curative gastrectomy with lymphadenectomy were recruited from the First Affiliated Hospital,Sun Yat-sen University,and examined retrospectively.In all cases,patients' age,gender,pTNM stage and survival time were identified and recorded.Results There were 208 carcinoma cases at gastroesophageal junction (GEJ,22.1％),261 fundus/body cases (27.7％),445 antrum/pylorus cases (47.2％) and 28 whole stomach cases (3.0％).Compared with fundus/body and antrum/pylorus carcinoma,GEJ carcinomas were more often seen in males,among older patients,with larger tumor size and deeper infiltrated tumors,higher stage and worse 5-year disease-free survivals.Whole stomach carcinoma had predilection in female,younger patients,and at later stages and worst 5-year disease-free survival.Conclusions Gastric carcinomas differ greatly in biologic behavior and prognosis by anatomic locations.GEJ carcinoma has independent biologic features.Whole stomach carcinoma is of the highest malignancy and worst prognosis.

Expression and proliferative regulation of miR-204 related to mitochondrial transcription factor A in colon cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To screen the microRNAs involved in colon cancer proliferation and to investigate the expression and regulating function of target miRNA in colon cancer.</p><p><b>METHODS</b>Mitochondrial transcription factor A(TFAM), which was proved to be an oncogene to colon cancer in prior study, was used as target gene. The microRNAs involved in colon cancer proliferation were screened with miRWalk 2.0 software. The expression of screened miRNAs was examined in 30 samples of colon cancer tissue, para-cancer tissue, normal colon cell strain, and 3 colon cancer strains (SW480, HT-29, and HCT116) by real-time PCR. MiR-204 presenting lowest expression was selected to further study in SW480 cells. Dual luciferase reporter assays was performed to examine the association of TFAM with miR-204. Anti-miR-204 lentivirus and miR-240 lentivirus were used to down-regulate and up-regulate miR-204 expression respectively. Change of TFAM protein expression in SW480 cells was detected by Western blotting, and change of SW480 cells proliferation was detected by MTT and BrdU assay after lentivirus transfection.</p><p><b>RESULTS</b>After screening, the candidate miRNAs were miR-204, miR-211, miR-214, miR-381 and miR-590-3p. Expressions of miR-204, miR-211, miR-214 and miR-381 were lower, but miR-590-3p expression was higher, in colon cancer tissues than those in para-cancer tissues(all P<0.05). Meanwhile expressions of above 4 miRNAs(miR-204, miR-211, miR-214 and miR-381) were also lower, but miR-590-3p expression was higher as well, in SW480, HT-29 and HCT116 cells compared to normal colon cells(all P<0.05). Among above 4 miRNAs, miR-204 showed the lowest expression in both colon cancer tissues and cell lines. Expression of miR-204 was negatively correlated with TFAM expression in colon cancer tissues(P<0.05). Dual luciferase reporter assays revealed TFAM could be integrated with miR-204 directly, suggesting TFAM as the direct target of miR-204. After up-regulating miR-204 by lentivirus, expression of TFAM decreased and proliferation increased in SW480 cells(all P<0.05). After down-regulating miR-204 by lentivirus, expression of TFAM increased and proliferation decreased in SW480 cells(all P<0.05).</p><p><b>CONCLUSION</b>MiR-204 inhibits TFAM expression and up-regulates the proliferation of colon cancer cells SW480.</p>

Role of surgery in the treatment of liver metastases from gastric cancer / 中华胃肠外科杂志

The development of liver metastases is a fatal event for gastric cancer patients, and remains a major cause of cancer-related death. Many studies showed that the 5-year survival rate is as low as about 10% in these cases. The management of liver metastases from gastric adenocarcinoma remains controversial. The different therapeutic modalities used are surgery, radiofrequency ablation, hepatic arterial infusion and palliative gastrectomy. Surgery is a good indication for single liver metastasis of gastric carcinoma less than 5 cm and not associated with another extra-hepatic metastasis. In this article we discuss the role of surgery in the treatment of liver metastases from gastric cancer.

Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): Chinese subgroup analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety profile of XELOX (capecitabine/oxaliplatin) in patients with locally advanced gastric cancer who underwent curative D2 resection in China.</p><p><b>METHODS</b>This is a subgroup analysis of Chinese patients in the capecitabine and oxaliplatin adjuvant study in stomach cancer (CLASSIC study), which was a randomised, open-label, multicentre, parallel-group, phase III( study in the Asia-Pacific region. A total of 100 gastric cancer patients who received curative D2 gastrectomy were enrolled in this study and were randomly assigned to either XELOX group (oral capecitabine combined with intravenous oxaliplatin chemotherapy) or the control group (surgery alone). This study aims to compare the 3-year disease-free between the two groups.</p><p><b>RESULTS</b>Subgroup analysis showed that 3-year DFS rate were 78% and 56% in XELOX and control group, respectively. The risk of relapse in XELOX group was reduced by 59% (HR=0.41, 95%CI:0.20-0.85, P=0.013), compared with the control group. The 3-year overall survival rate were 78% and 66% in XELOX and control group, with no statistically significant difference (HR=0.55, 95%CI:0.26-1.16, P=0.110).</p><p><b>CONCLUSION</b>Adjuvant XELOX chemotherapy following D2 gastrectomy may improve the survival in patients with advanced gastric cancer in China.</p>

Pathology features and management of small-size gastrointestinal stromal tumors / 中华胃肠外科杂志

The incidence of gastrointestinal stromal tumor(GIST) is 1-2 per 100 000. Micro GIST with a size less than 1 cm are found in 3%-35% elderly population. These small-size GIST are usually located in the middle or upper stomach, with gain-function KIT or PDGFRA mutation. In this review, the clinicopathological features and management of these small-size GISTs are discussed.

Efficacy analysis of laparoscopic surgery for primary local gastric and intestinal gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and short-term efficacy of laparoscopic resection of primary local gastric and intestinal gastrointestinal stromal tumors(GIST).</p><p><b>METHODS</b>Clinicopathological data of 26 patients with GIST, 20 located at the stomach and 6 at the intestine, undergoing laparoscopic complete resection from October 2010 to April 2013 were retrospectively analyzed.</p><p><b>RESULTS</b>Hand-assisted laparoscopic surgery was performed in 3 patients with gastric GIST, while the other 23 underwent regular laparoscopic surgery. All the procedures were performed successfully without conversion to open operation. According to tumor location and growth types, gastric local resection was performed in 18 cases, distal gastrectomy in 2 cases and intestinal segmental resection in all 6 cases of intestinal GIST. The mean diameter of tumor was (4.5±1.6) cm. The mean operational time was(96.2±28.2) min, with a mean blood loss of (49.6±38.6) ml. Postoperative bowel function recovery time was (2.3±0.7) d and the length of postoperative hospital stay was (6.8±1.9) d. Bleeding from gastrointestinal tract developed in 1 patient after resection of intestinal GIST. Postoperative pathology indicated very low risk of GIST in 1(3.8%), low risk in 13(50.0%), intermediate in 9(34.6%) and high risk in 3(11.5%) patients, respectively. After a follow-up ranging form 3 to 32 months, no recurrence or death was found.</p><p><b>CONCLUSION</b>Laparoscopic surgery of primary local GISTs from stomach or intestine is safe and feasible in selected patients, with less invasiveness, rapid recovery, and favorable short-term outcomes.</p>

Evaluation of para-aortic nodal dissection for locoregionally advanced gastric cancer with 1-3 involved para-aortic nodes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Prophylactic para-aortic nodal dissection (PAND) has no proven benefits for potentially curable advanced gastric cancer. However, the value of therapeutic PAND for involved para-aortic nodes (PANs) in patients with locally advanced gastric cancers has not been determined yet.</p><p><b>METHODS</b>Between 1998 and 2010, 157 gastric cancer patients with 1-3 involved PANs underwent extended D2 (D2+) lymphadenectomy plus PAND (PAND group, n = 69) or extended D2 lymphadenectomy alone (non-PAND group, n = 88). The clinicopathologic features and prognostic data were compared between the two groups. A propensity score-adjusted analysis was used for a balanced comparison.</p><p><b>RESULTS</b>The rate of PAN metastasis was 40.6% (28/69) in the PAND group. The 5-year survival rate was significantly higher in the PAND group than in the non-PAND group (43.7% vs. 31.8%, P = 0.044). Compared to the non-PAND group, the death hazard ratios in the PAND group were 0.45 (95% CI 0.274-0.739; P = 0.002) and 0.536 (95% CI 0.328-0.861; P = 0.0097) by multivariate analysis without and with propensity score adjustment respectively. Recurrence rate at 5 years was 39.1% in the PAND group and 43.2% in the non-PAND group (P = 0.628).</p><p><b>CONCLUSION</b>Extended D2 lymphadenectomy plus PAND is associated with superior outcomes for advanced gastric cancer patients with 1-3 involved PANs.</p>

Analysis of clinicopathological features of 1879 cases of gastric cancer in Southern China: a single center experience / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features of gastric cancer in Southern China, and provide a base of research and therapy for gastric cancer.</p><p><b>METHODS</b>A total of 1 879 cases of gastric cancer with radical gastrectomy from Southern China were collected from August 1994 to July 2012. Analyze and summarize the characters of gender, age, tumor location, WHO histopathologic type and grade, pTNM stage and family history, retrospectively.</p><p><b>RESULTS</b>Among all cases, male to female ratio was 2.08: 1, while female was more than male before 40 years (χ(2) = 77.831, P = 0.000). Cases aged over 60 years had a highest incidence of gastric cancer (46.0%), with predilection of sinus (45.7%), body (26.3%) and cardia (20.1%). The common WHO histopathologic types were tubular or papillary adenocarcinoma (81.5%) and signet ring cell carcinoma (11.0%). Most patients were at III or IV stage on pTNM staging (40.5% and 26.5%).</p><p><b>CONCLUSIONS</b>Gastric cancer in Southern China has a predilection on male, while female is more than male before 40 years. Gastric sinus and adenocarcinoma is most common. Most patients are diagnosed at advanced stages.</p>

Evaluation of the rationality of current T staging of gastric cancer with transverse mesocolon invasion / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the rationality of T staging of gastric cancer with transverse mesocolon invasion.</p><p><b>METHODS</b>Data of 808 patients with primary gastric cancer undergoing surgical treatment was screened from the Data base of Gastric Cancer of Sun Yat-sen University, from April 1996 to October 2009. According to the information of transverse mesocolon invasion, all cases were divided into groups NOI (T4a stage, non organ invasion, n = 638), NTMI (T4b stage, non transverse mesolon invasion, with organ invasion, n = 126), and TMI (transverse mesocolon invasion, n = 44). The clinicopathological features, surgical procedure and prognosis were compared among the three groups.</p><p><b>RESULTS</b>No significant difference was found in gender, age, lymph node metastasis, hepatic metastasis, tumor's Borrmann type, histological type, differentiation degree, value of serum CEA among the 3 groups (all P > 0.05). In the groups NOI, NTMI and TMI, the ratio of mean tumor diameter ≥ 5 cm was 39.0% (249/638), 61.1% (77/126) and 54.5% (24/44), respectively; the ratio of distal metastasis was 11.9% (76/638), 30.2% (38/126) and 43.2% (19/44), respectively; the ratio of peritoneal metastasis was 8.2% (52/638), 26.2% (33/126) and 38.6% (17/44), respectively; the ratio of TNM IV stage was 25.4% (162/638), 84.7% (107/126) and 93.7% (41/44), respectively; and the ratio of radical resection was 92.0% (587/638), 69.8% (88/126) and 77.3% (34/44), respectively; all with significant differences (P < 0.01), and the results of pairwise comparisons (Bonferroni correction, significant level α = 0.05/3 = 0.0167) showed that these parameters were significantly different between groups NOI and TMI (P < 0.0167), but non-significant between groups NTMI and TMI (P > 0.0167). The median survival time was 42.0, 16.4 and 19.0 months in the groups NOI, NTMI and TMI, respectively (P < 0.01), and the results of pairwise comparison showed that the prognosis were significant different between the groups NOI and TMI (P < 0.01), but non-significant between the groups NTMI and TMI (P > 0.05). In the cases who received radical resection, the median survival time was 47.9, 23.5 and 21.4 months in the groups NOI, NTMI and TMI, respectively (P < 0.01), and the results of pairwise comparison showed that the prognosis was significantly different between the groups NOI and TMI (P < 0.05), but not significant between groups NTMI and TMI (P > 0.05).</p><p><b>CONCLUSIONS</b>The tumor size, distal meatastasis, peritoneal metastasis, TNM stage, surgical procedure and prognosis of gastric cancer with transverse mesocolon invasion are similar to that of T4b gastric cancer, but are significantly different from that of T4a gastric cancer. Gastric cancer with transverse mesocolon invasion should be reclassified as T4b stage.</p>

Proximal gastric cancer: lymph node metastatic patterns according to different T stages dictate surgical approach / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>As a common form of gastric cancer migration, lymph node metastasis largely affects the surgical treatment and prognosis of gastric cancer. Surgery is the fundamental curative option for gastric cancer that varies depending on different stages. The study aimed to compare the clinicopathological characteristics and lymph node metastatic patterns in patients of proximal gastric cancer with different T stages and investigate a reasonable radical gastrectomy approach in terms of the range of lymphadenectomy for proximal gastric cancer.</p><p><b>METHODS</b>In our retrospective study, the data of 328 patients of proximal gastric cancer with different T stages were analyzed. By comparing the differences of lymph node metastatic rate and ratio, we investigated the clinicopathological characteristics and metastatic patterns of lymph nodes. Also, we were especially interested in the differences in survival rates between patients with and without No. 5 and 6 group metastasis with the same TNM stage.</p><p><b>RESULTS</b>The overall lymph node metastatic rate and ratio of advanced proximal gastric cancer were 73.4% and 23.3%, respectively. The tumors of different T stages were statistically significant in size and differentiation degree (P < 0.05), multivariate analysis showed that the depth of tumor invasion was an independent risk factor for lymph node metastasis in proximal gastric cancer (RR, 12.025; 95% CI, 2.326 to 62.157; P = 0.003). The overall survival rate of patients with No. 5, 6 group lymph node metastasis and those without was significantly different, but the differences in survival rates between patients with and without No. 5 and 6 group metastasis with the same TNM stage were not statistically significant.</p><p><b>CONCLUSIONS</b>Different T stages in proximal gastric cancer showed different patterns and characteristics of lymph node metastasis. D2 lymphadenectomy in patients with early gastric cancer had little survival benefit because metastasis to level 2 nodes was rare. Therefore the range of the lymph node dissection in radical gastrectomy for early gastric cancer was considered reasonable. Moreover, to meet the requirements of the lymph node dissection, total gastrectomy plus D2 lymphadenectomy or more are supposed to be applied for the advanced proximal gastric cancer patients. Precise T staging largely determines the range of gastrectomy and lymphadenectomy.</p>

Extended multi-organ resection for cT4 gastric carcinoma: a retrospective analysis

Objective: Combined resection for locally advanced [T4] gastric cancer may result in high morbidity and mortality. The aim of this study was to evaluate the clinicopathologic characteristics to determine the prognostic factors for T4 gastric cancers

Methodology: A total of 463 consecutive patients with gastric cancers were enrolled in this study. Among them, 63 patients received combined resections. Various clinicopathologic factors influencing survival rates were evaluated. Survival rates were calculated according to the Kaplan-Meier method. Prognostic factors were evaluated by the univariate and multivariate analysis

Results: Thirty-one patients [49.2%] received one additional organ resection and 32 patients [50.8%] received two or more additional organ resections. Curative resection was performed in 49 patients [77.8%]. Multivariate analysis identified curative resection [hazard ratio 0.330; 95 percent confidence interval, 0.139-0.784; P = 0.012] and tumor diameter [> 7 cm] [hazard ratio, 3.589; the 95 percent confidence interval, 1.425-9.037; P = 0.007] as independent prognostic factor for patients with T4 gastric cancer undergoing combined resection

Conclusions: The use of aggressive multi-organ resection was recommended for patients with T4 gastric carcinoma, with tumor diameter as a useful indicator. Patients with relatively small tumor diameter [