ABSTRACT
Objective To explore the therapeutic effects of radical mastectomy(RM) and extended radical mastectomy(ERM) for stage II, III breast cancer. Methods The 5 year and 10 year survival rates in 691 patients with stage II, III breast cancer treated either by extended radical mastectomy or radical mastectomy were retrospectively analyzed . Out of the 691 patients, 206 stage II cases and 193 stage III cases underwent RM, and 142 stage II and 150 stage III cases received ERM. Results In patients with stage II, III breast cancer located in the central portion or medial portion of mammary, the 5 year survival rates and in stage III patients 10 year survival rate after ERM were significantly higher than those after RM (P
ABSTRACT
Objective To study the diagnosis and radical resection of hilar cholangiocarcinoma. Methods Retrospective analysis was made on the clinical feature and the effect of radical resection on 38 cases of hilar cholangiocarcinomas.Results Diagnosis was made in all of the patients preoperatively.The radical resection was perfomed on 38 patients.Of them, 3(7.9%) died after operation.After operation, 5 cases (13.2%) developed bile leakage,and 2 of the 5 cases developed subphrenic abscess,which were cured by drainage; 4(10.5%) had right hydrothorax that was cured by conservative therapy; and 3(7.9%)had incision split that was cured by resuture. Among the 35 postoperative survivors,34 (97.1%) were followed up, the 1- and 3-year survival rates were 91.9% and 35.2%.None of the patients survived for 5 years. Conclusions It′s still difficult to make early diagnosis in hilar cholangiocarcinoma.The diagnosis mainly depends on the combination of imaging examinations. Nowadays the radical resection rate of hilar cholangiocarunoma is still low, the recurrence and metastasis are common after operation, and few patients can survive for a long time. It suggests that even in radical operation for hilar cholangiocarcinoma, the regions of resection and sweep are not enough,and the operative procedure needs to improve further.
ABSTRACT
Objective To evaluate the diagnosis and surgical treatment of hilar cholangiocarcinoma(H-CC). Methods Retrospective analysis was made on the clinical feature, surgical treatment and the effect on 73 patients with H-CC. Results Diagnosis was made in all of the patients preoperatively and the correct diagnostic rate of BUS was 69.9%. In the treatment, radical resection was performed on 15 patients with good results in a short-term period. Of the 43 patients who underwent biliary tract internal drainage or exterrnal drainage, 37 patients had good results in a short-term period, while 6 died after operation. Laparotomy or hepatic artery cannulization with chemotherapy was performed on 15 patients and no change occurred in a short-term period after operation. In 15 cases subjected to radical resection, 11 cases were followed up. The 1,3-year survival rates was 90.9%, 20.0% respectively, but none of the patients survived for over 5 years. In patients undergoing other operations, none survived more than 9 months. Conclusions It's still difficult to mak early diagnosis of H-CC, which mainly depends on imaging technics. The BUS should be choiced first. Radical resection rate is still low nowadays. The lobus quadratus resection is helpful to select the operation.
ABSTRACT
Objective To investigate the operation treatment of gallbladder carcinoma(GBC). Methods The clinical data of 132 patients with GBC from 1980 to 1999 were analysed. Results The mean age was 55 years and the occurrence sex ratio in female/male was 1.5∶1. Gallstone was found in 80% of the patients, and 87.1% of the GBC were adenocarcinoma. Before December 1990(forward group), simple cholecystectomy were performed on 11 cases, radical cholecystectomy on 9 cases, extended radical cholecystectomy on 5 cases, palliative extra- or intra- drainge on 15 cases, surgical biopsy on 30% cases. Hospital death occurred in 4 cases, the postoperative complications occurred in 20 cases including biliary fistula in 4 cases, pancreatic fistula in 2 cases. Since January 1991(latter group), radical simple cholecystectomy were performed on 2 cases, radical cholecystectomy on 16 cases, extended radical cholecystectomy on 24 cases; palliative extra- or intra- drainge in 9 cases, surgical biopsy on 8 cases. Hospital death occurred in 1 cases; postoperative complications in 12 cases, including biliary fistula in 1 cases, pancreatic fistula in 1 cases. Radical resection rate was 35.7% in forword group, 72.6% in latter group. Conclusions Surgical tech-nique progress and application with Peng's Multifunctional Operative Dissector can improve the resection rate of GBC. Extended redical resection is an effective and active method to treat middle or late stage GBC.
ABSTRACT
Objective To study the effect of hand-assisted laparoscopic anterior resection for rectal cancer(RC).Methods The clinical data of 28 cases of RC operated with hand-assisted laparoscopy were analyzed retrospectively. Results The operations in all the 28 cases were successfully performed, and no intra-or post-operative complications were observed.The number of resected lymph nodes and the resected margins from the tumor were sufficient.After operation,the patients felt less pain, recovered quicker and bowel movement recovered early;first postoperative flatus was appeared at 32 hours after operation;average postoperative hospital stay was 7 days.All the patients were followed-up for 8 to 19 months,and no trocar port tumor implantation or local recurrence occurred.Conclusions The results demonstrate that hand-assisted laparoscopic anterior resection in the treatment of RC have many advantages,such as safe,less trauma,the patients recover quicker,resection of the tumor more complete etc,so it can be used extensively.
ABSTRACT
Objective To determine the resectability of recurrent gastric malignant tumor and its clinical value, and to search an effective way to cure recurrent gastric malignant tumor. Methods The clinical data of 18 cases of sucessfully resected local regional recurrent gastric malignant tumor were analysed retropectively. Results In the 18 cases of recurrent malignant gastric tumor, 6 received total gastrectomy and lymphadenectomy, 5 received body and tail pancreatectomy plus splenectomy with lymphadenectomy, 2 got tumor resection in gastric bed, and the other 5 got periceliac tumor resection with lymphadenectomy. Pathology evidence revealed that 14 of them were gastric adenocarcinoma and the other 4 were gastric sarcoma. They were all recovered and got well when discharged. Follow up results revealed that resection of recurrent malignant gastric tumor could survive 16.4 months (7～38 months) averagely.Conclusions Patient's life quality and survival time could be improved if the local regional recurrence was resectable and other subsidiary therapeutic methods were used.
ABSTRACT
Objective To investigate the diagnosis and treatment of cystic adenoid tumor of the pancreas. Methods Retrospective analysis was made on the clinical data of 11 cases of pancreatic cystic neoplasms confirmed by operation and pathology at our hospital from 1978 to 1998. Results Cystic adenoid tumor of the pancreas is more likely to occur in young females with middle age, clinical presentations were as follows: a long-term persistent mass and distending pain in the epigastrium. Utrasounography, CT and ERCP could contribute to the diagnosis. Of the 11 cases, pancreaticoduodenectomy was performed in 2, distal pancreatectomy and splenectomy in 6, local excision of the mass in 2, and loop type cystojejunostomy in 1. The rete of resection was 90.9%. Of them, 1 case died of abdominal abscess and septicemia postoperatively. All the 10 cases who survived postoperatively were followed up. Among the 10 cases, 1 case of pancreatic cystoadenoma died of cardiac infarction 3 months after operation, and 1 case of cystoadenocarcinoma died of metastasis 51 months after tumor excision. The other 8 cases still alived well now. Conclusions Cystic tumor of the pancreas should be suspected when young or middle aged female patients have a long term big mass in epigastrium or left upper quadrant. Ultrasonography and CT scan are helpful in the diagnosis of the tumor including cystoademoma and cystoadenocarcinoma, Although the volume of the tumors may be very big, they often have a intact capsure,so easy to excise. The excision of the total tumor and some arounding pancreatic tissue is the first choice of the treatment for cystic tumor of the pancreas, and the curative effectiveness is satisfctory.
ABSTRACT
Objective To summarize the experience in transanal local excision (LE) for rectal cancer (RC). Methods The clinical data of 28 cases of RC treated by LE from 1988 to 1998 were analyzed retrospectively. Results In this series, five-year survival rate was 83.4?6.2%, and the local recurrence rate (LRR) was 17.8%. In well-differentiated carcinoma, 4 cases were convinced as local recurrence with a LRR of 17.4%(4/23); in moderately- differentiated carcinoma, one case with a LRR of 20.0%(1/5). The LRR in T 1 and T 2 group was 15.0% (3/20) and 25.0% (2/8) respectively. LRR was 16.7% (4/24) in patients with less than 1/3 bowel wall involved, LRR was 16.7%(4/24),whereas LRR was 25.0%(1/4) in more than 1/3 bowel wall involved group. In total bowel wall resection group the LRR was 16.7%(3/18) while in partial resection group was 20.0% (2/10). In patients with tumour size larger than 4 cm LRR was 22.2% (2/9), tumour size smaller than 4 cm LRR was 15.7% (3/19). Conclusion LE for RC might only be successfully performed in selected patients (T 1～T 2, N 0M 0, well or moderately-differentiated carcinoma,low RC within 6 cm from anal edge). The indications of transanal LE must be controlled strictly. Total excision of tumor and prevention of implantation of carcinoma are the main points in the prophylaxes of recurrence. Postoperative follow-up is needed in order to find local recurrence as early as possible.
ABSTRACT
Objective To evalute the diagnosis and the availability of local excision for the duodenal papilla tumor(DPT).Methods The clinical data of 12 patients with DPT treated by local excision in recent 9 years were retrospectively analysed.In this series,jaundice presented in 100% of patients and always accompanied with abdminal pain.Results There was no operation death in this seties.The preoperative diagnostic rate by biopsy was 75.0%. Ten patients(83.3%)were followed up for 1-5 years,5 patients with benign tumor were survival well.Four patients with early stage T 1 DPT were still survival for 62,31,84and 36months, respectively.Conclusions The indications of local excision for DPT include benign papillary tumor smaller
ABSTRACT
Objective To investigate the clinicopathological characteristics, diagnosis and treatment of primary duodenal malignant tumors (PDMTs). Methods The clinical data of 47 PDMTs confirmed by pathology were retrospectively analyzed. Results Pathological types were adenocarcinoma in 42 cases, leiomyosarcoma in 4, and carcinoid in 1.The most common location of the tumor was the descending portion (35), especially the peri-papillary region (28) of the duodenum. The most common symptoms and signs were abdominal pain, jaundice, upper gastrointestinal hemorrhage, obstruction ,and weight loss. The main diagnostic modalities were gastroduodenoscopy, GI barium meal, ERCP, ultrasound (US) and CT. US together with ERCP was the most useful in improving the diagnosis of peripapilla tumors in the duodenum. Panceraticoduodenectomy and some palliative procedures were performed for 25 and 20 cases, respectively.Surgical mortality and postoperative morbidity were 2.2% (1/45) and 20% (9/45),retrospectively. The 3-year and 5-year survival for those adenocarcinoma without distant metastasis undergoing pancreaticoduodenectomy were 50% and 32%. No long survival was found after the palliative operation. Conclusions Adenocarcinoma is the most common pathological type of PDMTs.No specific symptoms were shown in the early stage of PDMTs, US, CT and ERCP are the main diagnostic procedures. Radical pancraticoduodenectomy can prolong survival time and should be attempted for those without systemic dissemination.Palliative operations should be considered for tumors in advanced stage.
ABSTRACT
Objective To investigate the diagnosis,treatment and pathological characteristics of minute and small early gastric cancer(M EGC and S EGC).Methods The clinical and pathological parameters,and the diagnosis and treatment of 28 patients with M EGC or S EGC admitted to our hospital in recent 10 years were analysed retrospectively.Results There were 10 patients (12.4%) with M EGC,18( 22.2 %)with S EGC,and the proportion of M and S EGC in early GC is 34.6%.The diagnosis rate of gastric barium examination was 8.3% and that of gastroscopy with biopsy was 78.8%.All the carcinomas located in the body and antrum of the stomach.D1 radical gastrectomy(RGC) was performed on 6 patients and D2 RGC on the other 22 patients.The depth of tumor invasion in S EGC was significantly deeper than that in M EGC(P
ABSTRACT
Objective To summarize twenty year experience in the surgical treatment of hilar cholangiocarcinoma(H CC) and explore the effective measuers for increase in resectional rate and reducing operative morbidity and mortality of H CC. Methods Clinicopathological data of 201 patients with H CC treated surgically in our center between 1978 and 1997 were analysed retrospectively. The resection rate, operative morbidity and mortality of the patients before and after December 1990 were compared. Results Of the 201 patients, 97 underwent resection(redical resection in 51; palliative in 46), 84 subjected to internal or external drainage and 20 only laparotomy. In 75 followed up patients, the 1,3,5 year survival rate was 95.45%, 40.91%, 13.64% in radical resection group, and 55%, 10%, 0% in palliative resection group respectively; whereas in unresectional internal and external drainage group, 1 year survival rate was 36%, noone survived for more than 3 years. All the patients with only laparotomy died within 3 months after operation. Comparation of the two stages revealed that the resection rate had been increased from 34.95% before December 1990 to 62.24% after December 1990, and the radical resection rate from 15.53% to 35.71%, meanwhile the operative morbidity and mortality decreased from 39.80% and 17.84% to 18.37% and 6.12% respectively. Conclusions Radical resection plays an important role for improving long term survival rate in patients with H CC. Appropriately perioperative care can reduce the operative morbidity and mortality.
ABSTRACT
Objective To summarize the experience in major vessels reconstruction after resection of retroperitoneal neoplasm invided major vessel. Methods Sixteen patients with retroperitoneal neoplarsm invading major vessels underwent resection of the tumor companying with the inviding major vessels, and the resected vessels were reconstructed.Of them, 13 artificial vessels were placed for the vascular reconstruction,and 3 underwent inferior vena cava partial resection and repair with or without PTFE patch;combined reconstruction of arteries and veins were performed on 6 patients,and combined resection and reconstruction of vessels and other invaded organs were performed on 3 patients. Results There was no operative mortality in this series. Fourteen patients were followed up for 3-71 months( averaged 30 months) .Five patients died,in which 3 patients died within 12 months, 1died at 64 months and 1died at 71 months after surgery,respectively.There were no obstruction of the reconstructed vessels during follow up. Conclusions Combined resection of retroperitoneal neoplasm with invided major vessel and vascular reconstruction is a safe, effective operation for retroperitoneal neoplasm companying with inviding major vessel.