Retrospective analysis of short-term curative effect of total laparoscopic loop ileostomy reversal after radical resection of rectal cancer / 中华肿瘤杂志

Objective: To investigate the safety, feasibility and short-term efficacy of total laparoscopic loop ileostomy reversal in patients after resection of rectal cancer. Methods: The clinical data of 20 patients who underwent total laparoscopic loop ileoscopic loop ileostomy after radical resection of rectal cancer at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, or Beijing Chaoyang District Sanhuan Cancer Hospital from October 2019 to June 2020 were collected and retrospectively analyzed. Results: All patients had successfully underwent total laparoscopic ileostomy reversal without conversion to open surgery or discontinued operation. No perioperative related death cases were found. In the whole group, the median operation time was 97 (60-145) minutes and the median intraoperative blood loss was 20 (10-100) milliliters. The median Visual Analogue Scale (VAS) score was 1.9 (1-5) one day after the operation. Nobody needed to use additional analgesic drugs. The median time to grand activities was 25 (16-42) hours, the median time to flatus was 44 (19-51) hours, and the median hospitalization after operation was 6.9 (5-9) days. No patients underwent operation related complications such as operative incision infection, abdominal and pelvic infection, intestinal obstruction, anastomotic leakage, bleeding and so on. Conclusions: Total laparoscopic loop ileostomy reversal appears to be safe, feasible and with promising efficacy for selected patients.

Safety and feasibility of overlapped delta-shaped anastomosis technique for digestive tract reconstruction during complete laparoscopic right hemicolectomy / 中华肿瘤杂志

Objective: To explore the clinical safety and feasibility of overlapped delta-shaped anastomosis (ODA) in totally laparoscopic right hemicolectomy (TLRHC). Methods: From May 2017 to October 2019, of the 219 patients who underwent TLRHC at the Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 104 cases underwent ODA (ODA group) and 115 cases underwent conventional extracorporeal anastomosis (control group) were compared the surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications. Results: The length of the skin incision in the ODA group was significantly shorter than that in the control group [(5.6±0.9) cm vs. (7.1±1.7) cm, P<0.05], and the time to first flatus and first defecation after surgery in the ODA group was significantly earlier than that in the control group [(1.7±0.7) days vs. (2.0±0.7) days; (3.2±0.6) days vs. (3.3±0.7) days, P<0.05]. While the anastomosis time, operation time, intraoperative blood loss, the time of first ground activities, the number of bowel movements within 12 days after surgery, postoperative hospital stay, tumor size, the distal and proximal margins, the number of lymph node harvested and postoperative TNM stage in the ODA group did not differ from that of the control group (P>0.05). The postoperative complication rates of patients in the ODA group and the control group were 3.8% (4/104) and 4.3% (5/115), respectively, and the difference was not significant (P>0.05). Conclusion: The application of ODA technology in TLRHC can significantly shorten thelength of skin incisionand the recovery time of bowel function, and can obtain satisfactory short-term efficacy.

The expression of cortactin in colorectal cancer and its relationship with clinicopathological and prognostic parameters / 中华肿瘤杂志

Objective: To investigate the expression of cortactin in colorectal cancer and its correlation with clinicopathological parameters and prognosis. Methods: The expressions of cortactin in normal colorectal mucosal tissue and colorectal cancer tissue in paraffin-embedded tissue microarray from 319 patients who were diagnosed as colorectal cancer and treated in Cancer Hospital of Chinese Academy of Medical Sciences from 2006 to 2009 was detected by immunohistochemistry. Kaplan-Meier method and Log rank test were used for survival analysis, and Cox proportional risk regression model was used for multivariate analysis. Results: The positive expression rates of cortactin in colorectal cancer tissue and normal colorectal mucosal tissue were 61.1% (195/319) and 5.6% (18/319, P<0.001), respectively. T-stage, N-stage, American Joint Committee on Cancer (AJCC) stage, degree of tumor differentiation, neural invasion and preoperative carcinoembryonic antigen (CEA) levels were associated with the expression of cortactin (P<0.05). The positive expression of cortactin was associated with poorer disease-free survival (P=0.036) and overall survival (P=0.043), and the effect was more significant in patients with stage Ⅱ to Ⅲ. For patients with stage Ⅱ-Ⅲ colorectal cancer, postoperative adjuvant therapy was associated with disease-free survival (P=0.007) and overall survival (P=0.015). The vascular tumor embolus, pathological type, preoperative CEA level and cortactin expression were independent influencing factors for disease-free survival (P<0.05). The age, AJCC stage, preoperative CEA level and cortactin expression were independent influencing factors for overall survival (P<0.05). Preoperative CEA level and cortactin expression were independent influencing factors for disease-free survival and overall survival (P<0.05). Conclusion: Cortactin is expressed in colorectal cancer and in stage Ⅱ-Ⅲ patients, it is a potential predictor of colorectal cancer prognosis.

Application and prospect of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal metastasis from colorectal cancer / 中华肿瘤杂志

Colorectal cancer is one of the common malignant tumors in China, and its incidence is increasing with years. As the second most common metastatic site of colorectal cancer, peritoneum is difficult to diagnose early and with a poor prognosis. Systemic intravenous chemotherapy was used as the main treatment strategy for peritoneal metastasis in the past, but its systemic toxic and side effects were obvious, and it could not effectively control tumor progression. In recent years, the continuous development of surgical techniques, concepts, and equipment, as well as the introduction of new chemotherapy drugs and targeted drugs have significantly improved the quality of life and prognosis of patients with peritoneal metastasis of colorectal cancer. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can effectively eradicated the intraperitoneal free cancer cells and subclinical lesions, while reducing systemic side effects of chemotherapy drugs, and achieve the radical cure of the tumor at the macro and micro levels to the greatest extent. It has been used as the first-line treatment program for peritoneal metastasis of colorectal cancer at home and abroad. This article focuses on the analysis and summary of the survival efficacy, prognostic factor analysis, and chemotherapy safety of CRS+ HIPEC in the treatment of colorectal cancer peritoneal metastasis. The existing problems and controversies of HIPEC therapy are discussed simultaneously.

Development of a Recombinase-aided Amplification Combined With Lateral Flow Dipstick Assay for the Rapid Detection of the African Swine Fever Virus / 生物医学与环境科学（英文）

OBJECTIVE@#To establish a sensitive, simple and rapid detection method for African swine fever virus (ASFV) B646L gene.@*METHODS@#A recombinase-aided amplification-lateral flow dipstick (RAA-LFD) assay was developed in this study. Recombinase-aided amplification (RAA) is used to amplify template DNA, and lateral flow dipstick (LFD) is used to interpret the results after the amplification is completed. The lower limits of detection and specificity of the RAA assay were verified using recombinant plasmid and pathogenic nucleic acid. In addition, 30 clinical samples were tested to evaluate the performance of the RAA assay.@*RESULTS@#The RAA-LFD assay was completed within 15 min at 37 °C, including 10 min for nucleic acid amplification and 5 minutes for LFD reading results. The detection limit of this assay was found to be 200 copies per reaction. And there was no cross-reactivity with other swine viruses.@*CONCLUSION@#A highly sensitive, specific, and simple RAA-LFD method was developed for the rapid detection of the ASFV.

Analysis of short-term efficacy of overlapping delta-shaped anastomosis in totally laparoscopic left hemicolectomy for digestive tract reconstruction / 中华胃肠外科杂志

Objective: At present, though the laparoscopic delta-shaped anastomosis and overlapping delta-shaped anastomosis have been gradually applied to complete laparoscopic radical resection of left hemicolon cancer, the comparative evaluation of their efficacy has not been mentioned in the published literatures. This study aims to explore the safety, feasibility and short-term efficacy of overlapping delta-shaped anastomosis (ODA) in totally laparoscopic left hemicolectomy. Methods: A retrospective cohort study was performed. The clinical and pathological data of patients who underwent totally laparoscopic left hemicolectomy at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from May 2017 to October 2020 were retrospectively analyzed. The case inclusion criteria were as follows: (1) age of 18-75 years; (2) body mass index (BMI) of 18.5-30 kg/m(2); (3) descending colonic and proximal sigmoid colonic adenocarcinoma was confirmed by preoperative colonoscopy and pathology. The exclusion criteria: (1) multiple primary colorectal cancers; (2) uncontrolled or poorly controlled diabetes mellitus, immune system diseases, or hematological diseases; (3) severe intestinal obstruction; (4) left transverse colonic or splenic flexure colonic adenocarcinoma; (5) distant metastasis of liver, lung and other viscera determined by enhanced computed tomography in the chest, abdomen and pelvis. According to the above criteria, a total of 115 patients with left hemicolon cancer were enrolled. All the patients underwent totally laparoscopic left hemicolectomy. Patients who underwent laparoscopic traditional delta-shaped anastomosis were selected as the control group. Patients who underwent laparoscopic ODA were selected as the ODA group. Effects of these two laparoscopic reconstruction methods on postoperative recovery and perioperative complications were analyzed and compared. Results: A total of 60 patients were enrolled in the ODA group, including 32 males and 28 females, with mean age of (57.3±10.4) years and body mass index (BMI) of (25.0±3.1) kg/m(2). While mean 55 patients were enrolled in the control group, including 31 males and 24 females, with mean age of (56.7±9.9) years and BMI of (24.4±2.9) kg/m(2). There was no statistically significant differences between the two groups in gender, age, BMI, American Society of Anesthesiologist (ASA) classification, TNM staging, preoperative abdominal surgery history, neoadjuvant chemotherapy and nutritional status (levels of hemoglobin, lymphocyte count, prealbumin, and albumin) (all P>0.05). All the patients in both groups received R0 resection without conversion to open laparotomy or conversion to extra-abdominal anastomosis. The digestive tract reconstruction time of the ODA group was significantly shorter than that of the control group [(15.1±1.7) minutes vs. (15.9±2.4) minutes, t=-2.053, P=0.042]. There were no statistically significant differences in the total operation time, intraoperative blood loss, length of skin incision, tumor size, proximal and distal margins, harvested lymph nodes, postoperative first ambulatory time, and postoperative hospital stay (all P>0.05). However, the time to the first flatus and the first defecation in the ODA group was significantly shorter as compared to control group [(1.5±0.5) days vs. (1.7±0.5) days, t=-2.028, P=0.045; (3.1±0.6) days vs. (3.4±0.7) days, t=-2.095, P=0.039], indicating faster intestinal function recovery in patients with ODA. The morbidity of postoperative complication was 6.7% (4/60) in the ODA group and 7.3% (4/55) in the control group and no significant difference was found (χ(2)=0.016, P=0.898). Two cases of incision infection, 1 case of lung infection, and 1 case of intra-abdominal infection occurred in the ODA group, while 3 cases of lung infection and 1 case of intra-abdominal infection occurred in the control group. All these complications were resolved after conservative treatment, and no secondary operation was performed due to complications. Conclusion: Compared with the traditional delta-shaped anastomosis, ODA is associated with a faster recovery of postoperative intestinal function without increasing the morbidity of postoperative complications, and has the satisfactory short-term efficacy.

LMP2-DC Vaccine Elicits Specific EBV-LMP2 Response to Effectively Improve Immunotherapy in Patients with Nasopharyngeal Cancer / 生物医学与环境科学（英文）

Objective@#To evaluate the safety and effectiveness of a vaccine based on latent membrane protein 2 (LMP2) modified dendritic cells (DCs) that boosts specific responses of cytotoxic T lymphocytes (CTLs) to LMP2 before and after intradermal injection in patients with nasopharyngeal carcinoma (NPC).@*Methods@#DCs were derived from peripheral blood monocytes of patients with NPC. We prepared LMP2-DCs infected by recombinant adenovirus vector expressing LMP2 (rAd-LMP2). NPC patients were immunized with 2 × 10 @*Results@#We demonstrated that DCs derived from monocytes displayed typical DC morphologies; the expression of LMP2 in the LMP2-DCs vaccine was confirmed by immunocytochemical assay. Twenty-nine patients with NPC were enrolled in this clinical trial. The LMP2-DCs vaccine was well tolerated in all of the patients. Boosted responses to LMP2 peptide sub-pools were observed in 18 of the 29 patients with NPC. The follow-up data of 29 immunized patients from April, 2010 to April 2015 indicated a five-year survival rate of 94.4% in responders and 45.5% in non-responders.@*Conclusion@#In this pilot study, we demonstrated that the LMP2-DCs vaccine is safe and effective in patients with NPC. Specific CTLs responses to LMP2 play a certain role in controlling and preventing the recurrence and metastasis of NPC, which warrants further clinical testing.

Clinical parameters predicting pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer / 癌症

<p><b>INTRODUCTION</b>Preoperative chemoradiotherapy (CRT), followed by total mesorectal excision, has become the standard of care for patients with clinical stages II and III rectal cancer. Patients with pathologic complete response (pCR) to preoperative CRT have been reported to have better outcomes than those without pCR. However, the factors that predict the response to neoadjuvant CRT have not been well defined. In this study, we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer.</p><p><b>METHODS</b>A total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT, followed by curative surgery, between 2005 and 2013 were included. Patients were divided into two groups according to their responses to neoadjuvant therapy: the pCR and non-pCR groups. The clinical parameters were analyzed by univariate and multivariate analyses, with pCR as the dependent variable.</p><p><b>RESULTS</b>Of the 323 patients, 75 (23.2%) achieved pCR. The two groups were comparable in terms of age, sex, body mass index, tumor stage, tumor location, tumor differentiation, radiation dose, and chemotherapy regimen. On multivariate analysis, a pretreatment carcinoembryonic antigen (CEA) level of ≤ 5 ng/mL [odds ratio (OR) = 2.170, 95% confidence interval (CI) = 1.195-3.939, P = 0.011] and an interval of >7 weeks between the completion of chemoradiation and surgical resection (OR = 2.588, 95% CI = 1.484-4.512, P = 0.001) were significantly associated with an increased rate of pCR.</p><p><b>CONCLUSIONS</b>The pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR. These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.</p>

Mini-invasive surgery for colorectal cancer / 癌症

Laparoscopic techniques have been extensively used for the surgical management of colorectal cancer during the last two decades. Accumulating data have demonstrated that laparoscopic colectomy is associated with better short-term outcomes and equivalent oncologic outcomes when compared with open surgery. However, some controversies regarding the oncologic quality of mini-invasive surgery for rectal cancer exist. Meanwhile, some progresses in colorectal surgery, such as robotic technology, single-incision laparoscopic surgery, natural orifice specimen extraction, and natural orifice transluminal endoscopic surgery, have been made in recent years. In this article, we review the published data and mainly focus on the current status and latest advances of mini-invasive surgery for colorectal cancer.

Outcome analysis of simultaneous liver resection for synchronous liver metastases from colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the outcomes of simultaneous liver resection for patients who have primary colorectal cancer with synchronous hepatic metastases to see if there is any advantage for doing so.</p><p><b>METHODS</b>We retrospectively analyzed the medical records (1999 - 2009) of 53 consecutive patients with synchronously recognized primary colorectal carcinoma and hepatic metastases who underwent simultaneous (40 patients) or two-stage (13 patients) colonic and hepatic resections performed at our hospital.</p><p><b>RESULTS</b>There was no thirty-day mortality in both groups. The two groups had significant differences in mean operation duration [(212.9 ± 72.3) min vs. (326.5 ± 140.2) min, P = 0.014], mean blood loss [(337.5 ± 298.0) ml vs. (594.6 ± 430.5) ml, P = 0.020], post-operative hospital stay [(16.2 ± 8.1) day vs. (25.8 ± 8.5) day, P = 0.001]. The incidence rates of post-operative complications were 25.0% (10/40) and 53.8% (7/13), respectively, in the two groups (P = 0.053). The 1-, 3-, 5-year survival rates in the simultaneous resection group were 95.0%, 57.0% and 37.4%, respectively, with a median overall survival of 40.0 months and median disease-free survival of 14.0 months. The 1-, 3-, 5-year survival rates in the two-stage resection group were 92.3%, 58.7% and 36.7%, respectively, with a median overall survival of 38.0 months and median disease-free survival of 13.0 months. There were no significant differences between the two groups in respect of their survivals (P > 0.05).</p><p><b>CONCLUSIONS</b>Simultaneous colectomy and hepatectomy are safe and efficient for colorectal cancer patients who have synchronous colorectal liver metastases, with less complications and blood loss, and shorter hospital stay compared with the two-stage resection.</p>

Clinical analysis of 17 cases of gastric small cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the clinical data and prognosis of gastric small cell carcinoma (GSCC), summarize recent progress in diagnosis and therapy of this disease reported in the literature, and to provide the theoretical basis for its appropriate treatment.</p><p><b>METHODS</b>Clinicopathological data of 17 patients with pathologically confirmed GSCC, treated in our hospital between 1999 to 2012, were retrospectively reviewed.</p><p><b>RESULTS</b>There were 16 males and 1 female, ranged from 46 to 75 years (mean 64.6 years). The tumor was located in the gastric cardia in 13 cases, three in the gastric fundus, and one in the gastric body. All the 17 patients received surgery and 10 of them received postoperative adjuvant chemotherapy, one received preoperative adjuvant chemotherapy. Thirteen patients were followed up. Among them, two 1ived for 40 months all along, the other 3 cases died of recurrence and extensive metastasis in 6 month after operation. The median survival was 13.0 months. The median survival of the patients with and without lymph node metastasis were 42 months and 13 months, respectively. The median survival time of stage II and III patients were 24 months and 14 months, respectively.</p><p><b>CONCLUSIONS</b>It is difficult to make a definite diagnosis before or during the operation for GSCC. Radical operation could be done according to other gastric cancers and lymph node dissection could be simplified. Postoperative chemotherapy with the same scheme as lung small cell carcinoma may help to improve the outcome and prolong the survival of the patients.</p>

Clinicopathological features and prognosis of primary appendiceal adenocarcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the clinicopathological characteristics and prognostic factors of primary appendiceal adenocarcinoma.</p><p><b>METHODS</b>The clinicopathological data of 42 patients with primary appendiceal adenocarcinoma treated in the Cancer Hospital of Chinese Academy of Medical Sciences between March 1994 and October 2009 were retrospectively analyzed. The survival analysis was conducted using Kaplan-Meier method. The factors influencing survival were analyzed using univariate (Log-rank) and multivariate (Cox) models.</p><p><b>RESULTS</b>A total of 42 patients (29 female and 13 males, median age 56 years) with appendiceal adenocarcinoma were included in this study. Of them, 26 (61.9%) were mucinous adenocarcinoma, 12 (28.6%) were intestinal-type adenocarcinoma and 4 (9.5%) were signet cell carcinoma. 18 patients underwent curative resection, 20 patients received cytoreductive surgery, and 4 patients underwent biopsy only. Thirty patients received systemic chemotherapy (5-Fu-based regimens). One patient who died of postoperative pulmonary embolism on day 8 was excluded from the survival analysis. The overall 1-, 3-, and 5-year survival rate was 80.3%, 46.0% and 38.3%, respectively. Univariate analysis revealed that presence of symptoms of acute appendicitis, curative resection, histological grade, histological subtype, preoperative CEA level, systematic chemotherapy, and stage were all significant factors affecting the survival. Multivariate analysis showed that the preoperative CEA level (P = 0.01), histological grade (P = 0.001), and stage (P = 0.001) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>High level of CEA, G2/3 grade, and advanced stage are associated with poor prognosis in patients with primary appendiceal adenocarcinoma.</p>

Animal experimental study of compression anastomosis ring for low anterior resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of nickel-titanium compression anastomosis ring (CAR27) in colorectal anastomosis after low anterior rectal resection in animal models.</p><p><b>METHODS</b>End-to-end colorectal anastomosis was performed using CAR27 in 6 experimental pigs after resection of the middle and lower third of the rectum. The animals were observed postoperatively for up to 56 days. Five pigs were sacrificed at day 14 and the other at day 56. Distance from anal verge to anastomosis and anastomotic circumference were measured. Histopathologic examination was performed.</p><p><b>RESULTS</b>The median distance from anal verge was 5.3(4-6) cm. No anastomotic leak or other complications were observed. All the pigs recovered and gained weight. In 5 animals sacrificed at day 14, the mean circumference of the anastomosis was 6.8(6.5-7.0) cm, and histopathological examination showed mild inflammatory reaction and fibrosis. In the one sacrificed at day 56, the circumference expanded to 9.3 cm, and no inflammation and fibrosis were observed. Minor adhesion was noticed in only one pig, while smooth and intact serosa in the anastomosis was seen in the rest of the animals.</p><p><b>CONCLUSION</b>CAR27 is a promising device for mid and low colorectal anastomosis.</p>

Association between the number of retrieved lymph nodes in stage II( colorectal cancer radical resection and its prognosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association between the number of retrieved lymph nodes and the prognosis of stage II colorectal cancer.</p><p><b>METHODS</b>Clinical data of 380 patients with stage II colorectal cancer were analyzed retrospectively. SPSS 13.0 was used for data processing. Survival rate was calculated by Kaplan-Meier method, and risk factors related to prognosis of stage II colorectal cancer were analyzed by Logistic regression analysis. Recurrence rate and survival rate were assessed with Chi-squared test.</p><p><b>RESULTS</b>The average number of lymph nodes retrieved from 56 patients who developed recurrence or metastasis in 5 year after surgery was 9.5, and 16.3 from patients who had no recurrence or no metastasis(P<0.01). The number retrieved from 97 patients who died in 5 years after surgery was 11.1, and 16.7 from survivors. Patients were divided into 2 groups:>or=12 group and <12 group. The 5-year survival rate was 83.9% in >or= 12 group and 62.0% in < 12 group, respectively(P<0.01), the recurrence rate was 6.4% in >or=12 group and 25.7% in < 12 group (P<0.01). The univariable analysis showed that the number of retrieved lymph nodes was significantly associated with the survival and recurrence in patients with stage II colorectal cancer (P<0.05).</p><p><b>CONCLUSIONS</b>The number of retrieved lymph nodes is associated with the prognosis of stage II colorectal cancer. Patients with more retrieved lymph nodes have a higher survival rate.</p>

Prognostic factors of resectable pulmonary metastases from colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic factors for patients who underwent curative resection of pulmonary metastases from colorectal cancer.</p><p><b>METHODS</b>The clinicopathological data of 60 patients with pulmonary metastases from colorectal carcinoma who underwent a radical pulmonary metastasectomy between February 1985 and December 2004 at the Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively reviewed and analyzed.</p><p><b>RESULTS</b>The overall 5-year survival rate was 43.7% after pulmonary excision and 74.0% after colorectal resection. Three factors were identified as significant by univariate log-rank test for overall survival after pulmonary resection, they were preoperative carcinoembryonic antigen, number of pulmonary metastases (solitary vs. multiple), and hilar and/or mediastinal lymph node metastases (P < 0.05). Multivariate analysis showed that number of pulmonary metastases (solitary vs. multiple) and hilar and/or mediastinal lymph node metastasis were independent prognostic factors. However, shorter disease-free interval and more number of pulmonary metastases predicted poor prognosis after primary colorectal resection.</p><p><b>CONCLUSION</b>Pulmonary resection for metastases from colorectal cancer is safe and patients may get long-term survival in selected cases, especially in patients with a solitary pulmonary metastasis and without hilar and/or mediastinal lymph node metastasis.</p>

Wide local excision could be considered as the initial treatment of primary anorectal malignant melanoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Anorectal malignant melanoma was a rare disease with extremely poor prognosis. The aim of this study was to explore the clinical characteristic, diagnosis and treatment strategies of anorectal malignant melanoma.</p><p><b>METHODS</b>The data of 57 patients with anorectal malignant melanoma was collected and retrospectively analyzed.</p><p><b>RESULTS</b>Rectal bleeding and anal mass were found to be common symptoms of anorectal malignant melanoma. The preoperative diagnosis rate of anorectal malignant melanoma was 48.6%. The overall 3-year and 5-year survival rate was 38.0% and 21.3% respectively. The 3-year survival rates of stage I and II patients were 63.0% and 16.7% respectively (P = 0.000), and the 5-year survival rates were 33.3% and 11.1% (P = 0.001), which both had significant statistic differences. The 3-year survival rate of patients undergone abdmoninoperineal resection and patients undergone wide local excision were 36.7% and 53.0% respectively (P = 0.280), while the 5-year survival rate were 24.1% and 23.1% (P = 0.642), which both had no significant statistic differences.</p><p><b>CONCLUSIONS</b>This study identified no survival advantage to abdominoperineal resection in treatment of anorectal malignant melanoma, and we propose that wide local excision could be considered as the initial treatment of choice.</p>

Significance of positive ductal margin and prognostic factors of surgical resection in middle and distal bile duct carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the significance of a positive ductal margin and evaluate the prognostic factors related to surgical resection for middle and distal bile duct carcinoma.</p><p><b>METHODS</b>A retrospective clinicopathological analysis of 79 patients who had undergone surgical resection for middle or distal bile ductal cancer between January 1990 and December 2006 was conducted. The surgical procedures consisted of pancreatoduodenectomy in 46 patients, bile duct resection in 25 patients, bile duct resection plus hepatectomy in 6 patients, and bile duct resection with partial resection of portal vein in 2 patients. In 74 patients, 5 patients were excluded because they died after surgery without being discharged from the hospital, 15 clinicopathologic factors were evaluated using univariate and multivariate analysis.</p><p><b>RESULTS</b>The overall 5-year survival rate and the median survival time was 30.7% and 36 months, respectively. Sixteen of 74 patients (20.3%) were determined to have positive ductal margins on the final pathological examination. As a result, hepatic-side ductal margin, duodenal-side ductal margin and both was found to be positive in 6, 3 and 2 patients, respectively. Five patients had positive radial margins. The 5-year survival rate was 34.4% in 58 patients without microscopic residual disease (R0), and 15.5% in 16 patients with microscopic residual tumor (R1). The ductal recurrence rate of 16 patients with R1 resection was higher than 58 patients with R0 resection (62.5% vs. 17.2%, chi(2) = 13.024, P < 0.01). The 1-, 3-, and 5-year survival rates were better in the patients with R0 (92.5%, 56.7%, and 34.4%, respectively) than those in the patients with R1 resection (75.0%, 23.2%, and 15.5%, respectively) (P < 0.05). Twelve patients received postoperative adjuvant therapy. The 5-year survival rate was not significantly different between patients with postoperative adjuvant therapy and those without (18.2% vs. 31.8%, P = 0.221). The preoperative serum level of hemoglobin, pathological differentiation grade, the depth of neoplastic invasion, lymph node metastasis, R1 resection, and TNM stage were significant prognostic factors on the univariate analysis. Multivariate analysis revealed that lymph node metastasis and R1 resection were the independent prognostic factors.</p><p><b>CONCLUSIONS</b>In the treatment of middle and distal bile duct cancer, radical resection should be made to obtain a tumor-free margin. An aggressive surgical approach may improve the survival for middle bile duct cancer. Adjuvant therapy needs to be further developed.</p>

Analysis of factors related to recurrence after local excision for low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To discuss the factors predicting recurrence after local excision for low rectal cancer.</p><p><b>METHOD</b>Medical records and follow-up histories of 97 patients undergone local excision of adenocarcinoma of the rectum between April, 1975 and April, 2005 in Cancer Hospital of the Chinese Academy of Medical Sciences were reviewed retrospectively.</p><p><b>RESULTS</b>Postoperative pathologic examination revealed 28 pTis cases, 48 pT(1) cases, and 21 pT(2) cases. Eighty-nine patients underwent transanal excision, 7 transsacral excision, and 1 transvaginal excision. Twenty-two(45.8%) patients with T(1) tumors and 14(66.7%) patients with T(2) tumors were treated with postoperative radiotherapy with or without 5-fluorouracil. Seventeen(17.5%) patients presented recurrence, including 13 local recurrence, 2 local and distant recurrence, and 2 distant recurrence. The local recurrence rate was 15.5%. Median time to relapse was 27 months(range 4-73). The incidence of local recurrence were 7.1%, 12.5%, and 33.3% for patients with pTis, pT(1), and pT(2)(P=0.031) respectively. The local recurrence rate was 10.5%, 13.7%, and 3/5 for patients with pedunculated, sessile, and ulcerative carcinoma(P=0.017). The local recurrence of patients with T(2) tumors treated via local excision with or without chemoradiotherapy was 21.4%(3/14) and 4/7, but the difference was no significance(P=0.127). All the 15 patients with local recurrence underwent salvage resection, and the 5-year survival rate after salvage surgery was 59.6%.</p><p><b>CONCLUSIONS</b>Higher rates of recurrence are seen in patients with T(2) tumors and ulcerative carcinoma. Chemoradiotherapy or radical surgery should be chosen for T(2) tumors following local excision. Salvage resection should be considered after local recurrence.</p>

Clinical analysis of 98 cases of primary gastric lymphoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics, diagnosis and treatment regimens for the primary gastric lymphoma (PGL).</p><p><b>METHODS</b>The data of 98 PGL patients treated from January 1994 to December 2006 were collected and analyzed retrospectively.</p><p><b>RESULTS</b>Abdominal pain was the common symptom of PGL. All the patients were at stage I or stage II, and the preoperative diagnosis rate was 56.5%. The overall 1-, 3- and 5-year survival rates were 95.1%, 86.0% and 73.0% respectively. The 5-year survival rates of stage I and stage II patients were 89.5% and 66.7% respectively, and the difference was significant. The 5-year survival rate of patients received operations was 77.2% and that without operation was 75.0%, the difference was not significant.</p><p><b>CONCLUSIONS</b>The therapy based on chemotherapy is preferred for the treatment of PGL. In the cases of serious gastrointestinal complications, indefinite pathological diagnosis or non-effective chemotherapy, operations should be considered.</p>

Risk factors and surgical treatment of recurrent gastrointestinal stromal tumor in the rectum / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors and surgical treatment of recurrent gastrointestinal stromal tumors in the rectum.</p><p><b>METHODS</b>The clinical data of 24 cases,admitted to our hospital, were analyzed retrospectively. The possible risk factors were tested by chi(2)-test. The resectable rate and recurrent rate of recurrent cases were compared with the first-treated cases.</p><p><b>RESULTS</b>The tumors with biggest diameter >or=3 cm and high invasive risk had higher recurrent rates (chi(2)=4.874, P=0.027, chi(2)=6.659, P=0.010). The resectable rate of recurrent gastrointestinal stromal tumors in rectum was 64.3% (9/14), which was significantly lower than that of first-treated ones (23/24) (chi(2)=6.618, P=0.010). There was no significant difference of recurrent rate between the recurrent group and the first-treated group (chi(2)=1.459, P>0.05).</p><p><b>CONCLUSIONS</b>The size and invasive risk of tumor are associated with the recurrent rate of gastrointestinal stromal tumors in rectum. The resectable rate of recurrent gastrointestinal stromal tumors in rectum is significantly lower than that of first-treated ones, but recurrent rates are similar in the 2 groups.</p>