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Objective To investigate the clinical value of laparoscopic resection of gastric stromal tumors.Methods Thirty-two cases received this new type of operation.The tumors ranged in size from 1.5 to 5.5cm with a mean diameter of 2.6 cm.The operative methods included the full laparoscopic resection of(gastric) tumor and the hand-assisted laparoscopic resection of gastric tumor.Results All cases were(successfully) resected and no complications were observed.The mean operative time was 75min.The mean(intraoperative) blood loss was 50ml.Postoperative pain was slight.Postoperative flatus and feces were passed at a mean of 34 hours,and average postoperational hospital stay was 7.5days.Postoperative pathologic(examination) confirmed that 25 cases were benign GIST and 7 cases were of low-grade malignancy.No(recurrences) were observed at follow up of 8 to 30 months.Conclusions Laparoscopic resection of gastric(stromal) tumor is a technically simple,safe and effective procedure that could be widely used.
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Objective To investigate the reconstruction procedures of digestive tract following total gastrectomy.Methods The clinical data of pylorus ring preserving and jejunum interposition for the reconstruction of digestive tract following total gastrectomy in 17 cases of fundus and/or cardia carcinoma in past 3 years in our hospital were reviewed. Results There was no operative death,and no stomach fistula or constriction occurred in this series.All the 17 patients were discharged with recovery. Half a year after the operation, all the patients can eat about 200-300g each time, and 3-4 times a day. Patients′ subject feeling was good; no retrosternal burning pain occurred after meal; no symptoms of bile reflux or empty disorder happened. Conclusions The reconstruction of digestive tract following total gastrectomy using pylorus ring preservation and jejunum interposition should be effective if strict indications are adopted.
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Objective To study the clinicopathological features and treatment modality of patients with gastric remnant cancer after distal gastrectomy. Methods The data of 25 patients with gastric remnant cancer undergoing surgery during the recent 9 years were analyzed retrospectively.Results Patients with gastric remnant cancer showed a greater male predominance(5∶1). The mean interval between previous gastrectomy and diagnosis of gastric remnant cancer was 24.5 years,ranging from 12 to 35 years.The primary operation was Billroth Ⅱ reconstruction in 80% of the cases. R0 resection for gastric remnant cancer was performed in 14 cases,Palliative resection in 11 cases,and adjuvant chemotherapy in 18 cases. The 1-,3-and 5-year overall survival rate was 72.0%,56.0% and 36.0%,respectively,while the respective survival rate was 78.5%,71.4%,and 50.0% in radical surgery group,and 63.6%,36.3% and 18.1% in palliative surgery group(P
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Objective To study the outcome of surgical therapy of perforation of gastric cancer. Methods The clinical data of 37 cases with perforation of gastric carcinoma which underwent different surgical procedures were analyzed retrospectively. Among them,24 cases underwent partial gastrectomy,8 cases underwent radical mastectomy,4 cases had repair of perforation. 1 case received non-operative therapy. Results The preoperative diagnotic rate was 24.3%,and misdiagonsis rate was 75.7%. The perioperative mortality rate was 5.4%,including 1 case that underwent repair of perforation. The post-operative complication rate of patients undergoing palliative gastrectomy,radical gastric cancer operation and repair of perforation was 41.7%,25.0% and 75.0%,respectively,and the mean survival time was 25 months,29 months and 3.0 months,respectively.The partial gastrectomy and radical mastectomy patients had significantly better outcomes than those who underwent repair of perforation or received non-operative therapy.Conclusions For patients with perforation of gastric cancer with resectable lesions and who are in good general coaditon,a one-stage radical gastric resection or palliative subtotal gastrectomy can be performed.
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0.05).The operation time was longer,volume of bleeding was less,and postoperative time of bowel gas passage and hospital stay were shorter in laparoscopic group compared to those in open group(P0.05).Conclusions This study reveals that totally laparoscopic D2 gastrectomy is safe and feasible for advanced gastric cancer,and it presents the superior character of minimal invasion.
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Objective To investigate the effect of different operations for cardia carcinoma on the postoperative anastomotic stoma complications.Methods Between December,2000 and May,2007,the clinical data 156 patients with carcinoma of gastric cardia who received different operations were analyzed retrospectively.Results The thoracoabdominal incision was performed in 57 cases,abdominal incision in 68 and left thoracic incision in 31 cases.The occurrence rate of anastomotic stoma complications in the patients with thoraco-abdominal,abdominal and left thoracic incision was 7.0%(4/57),7.4%(5/68),and 12.9%(4/31),respectively.The occurrence rate of anastomotic stoma complications in the patients using 25 mm end-end autosuture was 4.2%(4/95),in using of the 28mm autosuture group was 16.1%(P=0.0102).Conclusions The occurrence rate of anastomotic stoma complications can be reduced by choosing correct operation methods and using autosuture correctly.
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Objective To explore the clinical efficacy of laparoscopy-assisted radical D2 proximal gastrectomy.Methods The clinical data of 22 cases of laparoscopy-assisted D2 radical proximal gastrectomy were analysed retrospectively.Results Laparoscopy-assisted radical proximal gastrectomy was carried out in all of the 22 cases. There was no conversion to open surgery in this series. The mean operation time was 188(162～270) min. The mean operative blood loss was 182(100～260)mL. The number of lymph nodes dissected was 18.6(10～32). The average time for gastrointestinal function recovery was 78(48～140)h. Postoperative anastomotic leakage occurred in one patient who had tumor invasion of distal esophagus, and it healed after 4 weeks of conservative treatment. There were no postoperative deaths in this series. All the 22 cases were followed up for 1～37 months (mean 9.2 months) and revealed no recurrence or metastasis.Conclusions Laparoscopy-assisted radical D2 proximal gastrectomy for early and advanced gastric cancer is feasible, safe, and minimally invasive.
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0.05).There was significant difference in lymph node metastatic rate between poorly-differentiated and undifferentiated adenocarcinoma(17.83%) compared with well-differentiated and middle-differentiated adenocarcinoma(1.58%)(P
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Objective To explore the use of gastroscopy and CT for staging and clinical guiding to the surgical therapy of advanced gastric cancer.Methods The preoperative gastroscopic and CT classification and the results of operative classfication of 182 cases of advanced gastric carcinoma were compared.Results The resection rate for low and undifferentiated adenocarcinoma and mucinous carcinoma on gastroscopic biopsy was low(64.1%),and the rate for diffuse infiltrative gastric carcinoma(6.7%)was significantly lower than that of mass tumor type(66.7%)and ulcerative type(61.8%).The total accuracy rate of CT staging was 91.21%.Sensitivity rate of CT diagnosis of perigastric invasion and/or metastasis was 72.22%.For lymph node staging the accuracy rate of CT was 74.2%,sensitivity rate was 74.1% and specificity rate was 74.3%.CT diagnosis of lymph node groups was blur.Conclusions Gastroscopy has an unreplaceable role in the final diagnosis of advanced gastric cancer and has significance for gross tumor grading,histologic biopsy diagnosis can be as a guide to dicide the treatment modality of advanced gastric cancer.CT has high degree of value for accuracy of clinical staging,and diagnosis of invasion of adjacent organs and lymph node metastasis.CT is superior to gastroscopy for judgement of resectability.Therefore,preoperative CT is a valuable guide for surgical treatment of advanced gastric cancer.
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Objective To explore the operative procedure and perioperative management of gastric cancer with liver cirrhosis.Methods Clinical data of 28 cases of gastric cancer with liver cirrhosis who were surgically treated in our hospital during the last seven years were retrospectively analyzed.Preoperatively,a detailed examination,and improvement of their nutritional status,liver function,and prothrombin time were aggressively made,and the possibility of tumor removal was estimated.Seven patients underwent radical proximal subtotal gastrectomy,and 4 of these cases underwent splenectomy and pericardial devascularizaion simultaneously.Five cases underwent total gastrectomy,and 3 of them had splenectomy and pericardial devascularizaion simultaneously.Twelve patients underwent radical distal subtotal gastrectomy,and 5 of these cases had splenectomy and suture of pericardial varices simultaneously.Four patients had palliative distal subtotal gastrectomy.The support of liver function and intense monitoring and management of complications were carried out postoperatively.Results Varying degrees of ascites occurred in all the 28 patients postoperatively,and other complications such as early liver coma occurred in five patients,extensive wound bleeding in three patients,left subdiaphragmatic abscess in one patient and wound infection in two patients.The morbidity rate was 100%(28/28).However,all the complications were recovered by non-surgical treatment.There were no perioperative deaths in this series.Conclusions Gastric cancer patients with liver cirrhosis are at a significant risk of developing postoperative complications.The surgical procedure should the "individual" principle based on liver function,history of upper gastrointestinal bleeding and the location of gastric carcinoma.Good hepatic reserve and perioperative care,meticulous hemostasis during operation,and prevention and treatment of postoperative complications are the likely determinants of operative prognosis.
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Objective To explore the safety and feasibility of laparoscope-assisted radical gastrectomy for gastric cancer.Methods Fifty-four cases of gastric cancer were selected to carry out laparoscope-assisted radical gastrectomy,including 12 radical total gastrectomies,18 proximal gastrectomies,and 24 distal gastrectomies.Lymphonodes were dissected by D1 in 29 cases and D2 in 25 cases.Results All of the 54 operations were performed successfully.The average operative time was(164.4?38.7)min in total gastrectomies,(142.4?35.2)min in proximal gastrectomies,and(149.1?35.4)min in distal gastrectomies.The mean volume of bleeding was(164.6?80.1)mL in total gastrectomies,(149.5?94.7)mL in proximal gastrectomies,and(152.5?87.7)mL in distal gastrectomies.The average number of lymphonodes dissected was 19.1?6.5 per case.After operation,the mean time of passage of gas via anus was(3.7? 0.7)d,and the mean length of hospital stay was(9.2?1.7)d.Two cases experienced postoperative anastomotic bleeding,and was controlled by conservative treatment.No other complications,such as anastomotic leakage,anastomotic obstruction,or duodenal stump leakage were experienced.Conclusions This results reveal that laparoscope-assisted radical gastrectomy is safe and feasible for gastric cancer.As long as the principles of cancer surgery are strictly followed,it can maintain radical tumor removal and exhibit the character of minimal invasion.
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Objective To explore the value of CT in the preoperative assessment of resectability of advanced gastric carcinoma.Methods The relation of CT findings and operative data in 93 cases of advanced gastric carcinoma were retrospectively analyzed.Results There were 23 cases of fundus and cardia carcinoma,59 cases of carcinoma of gastric corpus,and 11 cases of carcinoma of antrum.All cases showed increased thickness of gastric wall in various degrees,some of the cases showed tumor growth in the gastric wall,ulcer of the mucosa,stricture of gastric cavity and cardia,increased thickness of cardiac wall,and invasion of lower esophagus and perigastric organs.The accuracy of location and definitive diagnosis by CT,compared to gastroscopic biopsy and postoperative pathology,was considerable,and the detecting rate of tumor by CT was 100 %.CT had important reference value in preoperative evaluation of tumor resectability.The excision rate in the predicted operable group was 93.3 %;in the predicted unresectable group,the non-excision rate was 75.0%.Conclusions Preoperative CT diagnosis of gastric carcinoma has important clinical significance.CT provides a high reference value for assessing the resectability of gastric carcinoma,and it is worthy of widespread use.
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Objective To discuss the effect of intra-operative and post-operative hyperthermic intraperitoneal lavage chemotherapy for Ⅲb and IV gastric cancer on post-operative peritoneal metastasis and survival rate.Methods The clinical data of 31 cases of gastric cancer(control group)who underwent operation only and 50 cases(chemotherapy group)who receved operation combined with intra-operative and post-operative hyperthermic intra-peritoneal lavage chemotherapy were comparatively studied.Results The survival rate of control group after 2 years and 3 years was lower than that of the chemotherapy group,and the intraperitoneal recurrence raue of cootrol group after 2 years and 3 years was higher than that of chemotherapy group.Conclusions Intra-operative and post-operative hyperthermic intraperitoneal lavage chemotherapy for gastric cancer has important significance in prevention and treatment of peritoneal metastasis and can improve survival rate.
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Objective To analyze the clinical diagnosis and treatment of recurrent cancer in gastric remnant.Methods Clinical data of 48 patients who underwent surgical re-operation because of recurrent carcinoma within gastric remnant after radical resection of gastric cancer were analyzed retrospectively.Results All 48 cases were recurrent cancer in gastric stump.The time of recurrence was 6-36 months after first radical resection.After reoperation,the mean survival time of 28 patients(58.3%)who underwent radical resection was 40 months;the mean survival time of 20 patients(41.7%)who received palliative treatment was 14.8 months(P
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Objective To investigate the earlier diagnostic methods and operative procedures of gastric remnant cancer. Methods Clinicopathologic data of 19 cases of gastric remnant cancer were retrospectively analysed,and the diagnostic value of the gastroscopy and barium meal was compared.Influencing the prognosis of gastric remnant cancer treated by different operations according to the situation seen during operation were observed. Results The diagnostic rate of gastroscopy and barium meal was 78.9% and 47.4%, respectively.All the 5 cases who underwent radical remnant gastrectomy sarvived≥3 years postoperatively.Two of the 3 cases who underwent palliative remnant gastrectomy survived 2 years and 1 alived 1.5 years postoperatively. In 6 cases of gastrojejunostomy, 4 cases died within half year, 2 cases died 12.5 and 14 months postoperatively. Conclusions The diagnostic value of gastroscopy takes advantage over barium meal examination. The patients who treated by radical remnant gastrectomy have better prognosis.
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Objective To explore a method to improve the nutritional state and immune function of patients after radical gastrectomy,and to decrease postoperative complication rate and accelerate recovery from operation.Methods In line with the concept of fast tract surgery (FTS),a new perioperative nutritional schedule was made for patients prior to radical gastrectomy,ehich included preoperative nutritional risk screen and prophylactic enteral nutrition,early postoperative light enteral nutrition,early ambulation and perioperative nursing care.Patients with gastric cancer were randomly assigned into fast track group or a simple control group.New perioperative schedule was executed in the patients of fast track group and traditional nutrition support in control group.After operation,serum albumen was measured to evaluate the patient's nutritional state and serum IgA to evaluate gastrointestinal immune function.In addition,the time to passage of flatus,postoperative recovery time and complication rate after operation were compared.Results Patiens in FTS group (n=35) showed higher serum albumin and serum IgA on d1 and d3 after operation than those in the control group (n=25) (P
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Objective To analyze the clinicopathologic features,effect of surgical treatment and prognosis of elderly patients with gastric cancer.Methods The records of 84 elderly patients(aged 80 years or above) with gastric cancer who underwent operation in our hospital from 2000-2008 were analyzed retrospectively.Results Ten patients had early gastric cancer(1a,8 cases,1b,2cases),stage II 12 cases,stage III 45 cases(53.6%) and stage IV 17 cases.Among them,81% patients had one or more co-morbidities.Cardiovascular disease was present in 43 cases(51.2%).Resection rate was 85.7%(72/84).Radical resection rate was 60.7%(51/84).Limited nodal dissection(
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Objective To appraise the postoperative anti-reflux function of vertical esophagogastic valve-plasty anastomosis for cardiac cancer.Methods Forty patients with cardiac cancer were randomly divided into study group and surgery control group,with 20 patients in each group.The study group underwent vertical esopagogastric valve-plasty anastomosis,while the surgery control group underwent conventional esophagogastrostomy.Ten healthy volunteers were recruited as normal control group.A 24-hour esophageal pH monitoring and endoscopy check-up was carried out in all experimental subjects at 90 days postoperatively.Results All of the pH monitoring indexes in study and surgery control groups were higher than those in normal control group(P
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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.
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6 years. Conclusions The total gastrectomy D 2 or D 2 + with Roux en Y anastomisis procedure for the upper portion carcinoma of stomach can resect the lymph nodes completely, and postoperative complications are reduced. If the indications and techniques could be standerized, the postoperative 5 years survival rate might be increased.