ABSTRACT
Objective: To analyze and evaluate the results of endoscopic screening for upper digestive cancer in Danzhou city of Hainan, China. Methods: Totally 300 8 subjects aged from 40 to 69 years old were selected by cluster sampling method for screening of upper digestive tract cancer in Danzhou from 2015 to 2017. Results: In total, 13 cases (0.43%) of high grade intraepithelial neoplasia and cancer were detected. The detection rate of esophageal cancer, cardia cancer and gastric cancer was 0.07% (2 cases), 0.07% (2 cases) and 0.30% (9 cases), respectively. The diagnosis rate of early cancer was 92.31% (12 cases) and the treatment rate was 46.15% (6 cases). Conclusion: Endoscopic Screening is an effective way to detect precancerous lesions and early cancer. The detection rate in Danzhou is lower than the national average. Improving the professional and management ability of screening project team, mastering the incidence and mortality trend of upper digestive tract cancer, is key to the implementation and evaluation of the project of early diagnosis and treatment of upper digestive tract cancer.
ABSTRACT
Objective To study the postoperative recovery of different surgical approaches for patients with cardia cancer.Methods From January 2011 to March 2016,174 cases of patients with cardia cancer were selected and divided into observation group (76 cases) and control group (98 cases).The patients of control group received via thoracic approach surgery,while those of observation group were given abdominal approach surgery.The operationtime,intraoperative blood loss,dissected lymph node numbers,postoperative hospital stay,hospitalization expense,positive rate of surgical margin,radical operation rate,perioperative mortality,pulmonary complications,operative incision infection rate and anastomotic fistula rate of two groups were compared.Results There were no significant differences of intraoperative blood loss and operation time,positive rate of surgical margin,radical operation rate,perioperative mortality,postoperative pneumothorax rate,hydropneumothorax rate,pyothorax rate,operative incision infection rate and anastomotic fistula rate between two groups (P ＞ 0.05).There were significant differences of the dissected lymph node numbers,postoperative hospital stay,hospitalization expense,postoperative hydrothorax rate,postoperative pneumonia rate,total pulmonary complications rate and total complications rate between two groups (P ＜ 0.05).Conclusions Abdominal approach for patients with cardia cancer,compared to via thoracic approach surgery,presents advantages in terms of dissected lymph nodes,postoperative hospital stay,hospitalization expense,postoperative pneumonia rate,hydrothrax rate,total pulmonary complications rate and total postoperative complications rate.
ABSTRACT
Objective:To investigate the incidence rate of upper digestive tract cancer in Cixian, China, a particular area with high inci-dence of esophageal cancer. Methods:Statistical analysis was performed on the 2003-2012 incidence data of upper digestive tract can-cer in Cixian. The annual incidence rate, Chinese population standardized incidence rate (the bid rate), and structure of world popula-tion standardized incidence rate (referred to as the world standard rate) were calculated. The incidence data were divided into two groups according to period (2003-2007 and 2008-2012), and different age groups were compared. Results:From 2003 to 2012, the in-cidence of upper gastrointestinal cancer was 165.36/10 million. The 2003-2007 crude incidence rate was 171.55/10 million), whereas 2008-2012 crude incidence rate was 151.41/10 million which has reduced over the last five years. Esophageal cancer incidence from 2003 to 2012 had a crude incidence rate of 108.05/10 million during the two periods (from 2003 to 2007, the incidence rate was 116.87/10 million;and from 2008 to 2012, 99.58/10 million), the crude incidence rate of the latter 5-year period has declined obvious-ly. From 2003 to 2012, the overall crude incidence rate of cardia cancer was 31.21/10 million, comparison of two peaiods (from 2003 to 2007 was 29.11/10 million, and 2008-2012, 33.23/10 million) indicated that the level of measurement of the latter period in-creased. At the same period, the overall incidence rate of gastric cancer was 26.10/10 million, comparison of the two periods (2003-2007 the crude incidence rate was 25.57/10 million, 2008-2012 was 26.60/10 million) indicated that the level of the parameter in the latter 5 years increased slightly. Conclusion:The incidence of esophageal cancer in Cixian decreased significantly, but the area remains to have the highest incidence rate of cardiac cancer morbidity. The incidence rate of distal gastric cancer increased significantly in males but decreased slightly in females, which suggests that early diagnosis and treatment of gastric cardia and distal stomach cancer is extremely important.
ABSTRACT
Objective To evaluate the clinical and pathological characteristics and risk factors of the prognosis of Cardia cancer.Methods Clinical data of 52 cases of cardiac cancer patients who were treated by surgery and follow-up data were collected from June 2009 to August 2011.Factors influencing the prognosis of the patients were analyzed by univariate and multivariate analysis.Results The survival rates in 1,2,3years were 73％,54％,46％.Single factor analysis showed that there was a significant correlation between T stage,N stage,TNM stage,classification Siewert,MSLN and venous invasion.Stepwise Cox proportional hazard model showed that T stage,N stage and MSLN were independent risk factors.Peritoneal and liver were the main way of recurrence and metastasis.Peritoneal metastasis was related to T stage and lymph node invasion,while the liver metastasis was related to MSLN.The survival curves of patients with Kaplan-Meier showed that the survival period of patients with liver metastasis and peritoneal metastasis was significantly shortened.Conclusion Standardization of lymph node cleaning is a key factor affecting prognosis,D2 surgery should be an operation standard in cardia cancer.
ABSTRACT
Objective To compare T and N staging of esophageal and cardia cancer by endoscopic ultrasonography (EUS) and computed tomography (CT) before operation, and to evaluate clinical value of EUS.Methods Twenty-eight patients received examination of EUS and CT preoperatively, and the T and N staging was determined. The accuracy rates of both T, N staging were compared by the postoperative pathological results, at the same time, the accuracy rates of lymph node metastasis were compared, and the value of application of EUS was investigated. Results In the twenty-eight cases, the accuracy rates of EUS were higher than that of CT by 89.3% ( 25/28 ) to 46.4% ( 13/28 ) in T staging. And the difference had statistical significance( P = 0. 004 ,P ＜ 0.01 ). The N stagings of both were 82.1% (23/28) and 50.0% ( 14/28), and the difference had statistical significance ( P = 0. 035, P ＜ 0. 05 ). The accuracy rates of lymph node metastasis of both were 88.7% and 72.2% respectively, and the difference had statistical significance (χ2 = 7.031,P = 0.008, P ＜ 0. 01 ). Conclusions EUS has very important value in preoperative staging for esophageal cancer and cardia cancer, and the T staging of EUS is better than that of CT. The short axis and the ratio of short to long axis (S/L) combined with the lymph node ultrasonography image can improve the accuracy rates of lymph node metatsasis and N staging.
ABSTRACT
PURPOSE: The incidence of upper gastric cancer and especially the diffuse type have increased in western countries. The aim this study was to investigate the chronologic changes of the clinicopathological features and survival rates of Korean upper gastric cancer patients. MATERIALS AND METHODS: 1,638 gastric cancer patients who underwent gastrectomy were included in this study and they were divided into two groups; the 1990's (1991~1999, n=987) and the early 2000's (2000~2003, n=651). We evaluated the differences of the clinicopathologic features and the factors that affected the survival rates by univariative and multivariative analysis. RESULTS: The older age (>60) patients increased from 42.7% to 50.7% respectively. Being overweight (body mass index> or =23) also increased from 31.5% to 43.2%. For the pathology, the incidence of stage Ia gastric cancer increased (29.8% to 44.5%) and the incidence of stage IV gastric cancer decreased (23.5% to 11.8%). Yet there was no difference according to the WHO classification, Lauren's classification and the location of tumor between the groups. The 5 year survival rates increased 67.7% to 83.7%, according to the group. Multivariative analysis showed that the odd ratios of the early 2000s was 0.715 (95% CI; 0.555~0.921) as compared to that of the 1990s. CONCLUSION: There were no changes of the clinicopathologic features, like the pattern in western countries, although the incidence early gastric cancer, old age patients and overweight patients increased. The survival rate of early 2000s was better that that of the 1990s.
Subject(s)
Humans , Gastrectomy , Incidence , Overweight , Stomach Neoplasms , Survival RateABSTRACT
PURPOSE: Due to the biological characteristics of cardia cancer, prognosis is poor. It is therefore essential to achieve a sufficient proximal resection margin to maximize survival. The authors studied gastric cardia cancer, focusing on adenocarcinoma. METHODS: One-hundred fifty patients who were diagnosed with gastric cardia cancer and underwent surgery between January 1990 and December 2006 by a single surgeon were included in this study. RESULTS: Of the 150 cases, 141 were adenocarcinomas, 4 were carcinomas, and 3 were leiomyosarcomas. In the adenocarcinoma group, the male-to-female ratio was 2.62:1. There were 2, 60, and 79 (56.0%) cases of adenocarcinoma type I, II, and III, respectively, and there were 32 (22.7%), 18 (12.8%), 70 (49.6%), and 21 (14.9%) cases of stage I, II, III, and IV tumors, respectively. The mean distance from the proximal tumor to the resection margin was 1.93+/-2 cm pathologically, and there was tumor invasion of the resection margin in 4 cases (2.8%). In the 10 cases of extended surgery in type II, the mean distance was 5.85+/-3.67 cm, with no tumor invasion of the resection margin. Recurrence occurred in 30 (21.3%) cases, and 5 of those cases were local anastomotic site recurrences. Cumulative survival was 81.3%, 77.8%, 51.4%, and 28.6% for stage I, II, III, and IV tumors, respectively. CONCLUSION: Although it is possible to remove the tumor with an appropriate resection margin by only an abdominal incision, the surgeon should always keep in mind the possibility of a thoracoabdominal incision when operating on a patient with esophageal infiltration.
Subject(s)
Humans , Adenocarcinoma , Cardia , Esophagogastric Junction , Leiomyosarcoma , Population Characteristics , Prognosis , RecurrenceABSTRACT
PURPOSE: Radical surgery is the standard therapy for patients with resectable cardia cancer. In the case of type II disease with esophageal invasion, a transhiatal extended radical total gastrectomy is needed or a gastroesophagectomy through an abdomino-thoracotomy, depending on the extent of the esophageal invasion. We analyzed the indications and outcome of left colon interposition as an esophageal substitution. MATERIALS AND METHODS: Between 1 January 1994 and 31 December 2006, 10 patients underwent left colon interposition after gastroesophagectomy through an abdomino-thoracotomy or the tanshiatal approach for type II cardia cancer at the Department of surgery, Yonsei University College of Medicine. The outcomes of these patients were reviewed and compared, with those who underwent a Roux-en-Y, by gender and age matched analysis, retrospectively. RESULTS: There were nine males and one female with a mean age of 52.5 (range, 16~72). The operation time was 449.00+/-87.39 minutes. The mean distance between the proximal resection margin and the cancer was 6.56+/-3.65 cm; the maximum size of the tumor was 9.90+/-3.97 cm. These measures differed significantly from patients who underwent Roux-en-Y. The patients had a double primary cancer in the cardia and esophagus. There were no events of colon necrosis. However, a pneumothorax occurred in one patient (10%) and a proximal anastomotic stricture occurred in one patient. There were no reports of heartburn, regurgitation, thoracic or epigastric fullness, and one patient even gained weight, 16 kg. CONCLUSION: Colon interposition after esophagogastrectomy was safe and effective and should be considered as an additional surgical option for locally advanced type II cardia cancer patients with esophageal invasion.
Subject(s)
Female , Humans , Male , Cardia , Colon , Constriction, Pathologic , Esophagus , Gastrectomy , Heartburn , Necrosis , PneumothoraxABSTRACT
Objective To observe the effect of radiotherapy combined with chemotherapy for patients with cardia cancer who could not take operational treatment.Methods 37 patients with advanced cardia cancer received treatment of 6MV-X linear accelerator convention radiotherapy for 6 weeks.After taking radiotherapy,they received chemotherapy with DDP(20mg) and 5-Fu(500mg) for 3～6 cycles.Results The clinical symptom obviously alleriates,X-ray barium medicinal preparation absorbs the piece to demonstrate the complete response rate of 8%(3/37),the total effectiveness rate was 87%(32/37).1,3-years survival rates respectively were 65% and 11%.Conclusion Radiotherapy combined with chemotherapy for advanced cardia cancer can improve the clinical symptom and improve the surviral quality and lengthen the life.
ABSTRACT
Objective To investigate the efficacy of thoracoabdominal mini-incision surgery for the treatment of gastric cardia cancer. Methods Radical resection of gastric cardia cancer was performed on 60 patients from January 2002 to January 2007. Thoracoabdominal mini-incision was used in 30 cases, and posterolateral thoracotomy was carried out in the other 30 patients. The data of the two groups were retrospectively analyzed. Results The operations were accomplished without death or severe complications in all the patients. Compared with the posterolateral thoracotomy group, thoracoabdominal mini-incision group had shorter incisions [(12.4?0.7) cm vs (19.2?2.0) cm, t=-17.577, P=0.000], shorter operation time [(207.3?76.1) min vs (260.0?85.6) min, t=-2.519, P=0.015], earlier postoperative ambulation [(2.3?0.5)d vs (3.4?0.5) d, t=-8.521, P=0.000], less thoracic drainage [(276.7?58.7) ml vs (308.7?59.5) ml, t=-2.097, P=0.040], less analgesic (pethidine) requirement [(66.7?27.3) mg vs (113.3?45.4) mg, t=-4.818, P=0.000], shorter duration of oxygen use [(3.8?2.0) d vs (5.1?2.6) d, t=-2.171, P=0.034], and higher arterial oxygen saturation[(97.6?2.7)% vs (96.1?2.7)%,t=2.152,P=0.036]. No significant difference was observed between the two groups in the number of dissected thoracic lymph nodes (1.87?0.43 vs 1.93?0.37, t=-0.579, P=0.565), number of dissected celiac lymph nodes (4.00?0.45 vs 3.97?0.49, t=0.247, P=0.806), postoperative hospital stay [(11.8?1.0) d vs (12.0?1.2) d, t=-0.701, P=0.486), pulmonary infection (2 vs 5, ?2=0.647, P=0.421), atrial fibrillation (2 vs 4, ?2=0.185, P=0.667) and positive surgical margins (0 vs 1, ?2=0.000, P=1.000). The two groups were followed up for (36.3?13.9) months and (36.3?16.5) months, respectively (t=0.024, P=0.981), no significant difference was detected between them in the 1- and 3-year survival cases (19 vs 22, ?2=0.487, P=0.485; and 10 vs 12, ?2=0.194, P=0.660) and chest pain (2 vs 3, ?2=0.000, P=1.000) during the period. Conclusions By using a thoracoabdominal mini-incision, gastric cardia cancer can be resected completely with less trauma. The approach is ideal for clinical application.
ABSTRACT
Objective To explore the clinical significance of MDR1 gene expression inpatients with gastric cardia carcinoma.Methods Using reverse transcription-polymerase chain reaction(RT PCR), the genes expression of MDR1 and MRP, in 4 6 cases of gastric cardia cancer was determined.Results Positive expression of MDR1 and MRP gene were 6:3% and 50% respectively, which was muchhigher than that in tissue adjacent to 1ilo cancer site. In 9 cases of pre-operative chemotherapy , the levels ofMDR 1, and MRP gene expression were higher higher that without chemotherapy (P
ABSTRACT
0. 05). More patients in Group A could swallow normal diet than group B (P
ABSTRACT
Objective:To explore the perioperative treatment for esophageal cancer patients concomitent with diabetes.Methods:74 operation cases of esophageal and gastric cardia cancer associated with diabetes were analyzed retrospectively from 1976 to July 2003.Results:The occurrence of esophageal and gastric cardia cancer patients concomitent with diabetes was 6.1% among the esophageal cancer operative cases in the same period. The morbidity was 12.2% (including pulmonary infections in 2 cases,incision infection in 1,anastomosis fistula in 2,HHNC in 2 and hypoglycemia in 2 cases).The perioperative mortality was 1.4% with one patient dying of respiratory failure caused by pulmonary infection.Conclusion:Esophageal and gastric cardia cancer patients associated with diabetes are found to be common in thoracic operations (6.1%).It is crucial to control these patients for low morbidity and mortality through enough preparation,satisfactory aneathesial management and good nutrition support perioperatively.