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Objective:To analyze the clinicopathological characteristics of differentiated early cardia cancer and to evaluate the short-term and long-term efficacy of endoscopic submucosal dissection (ESD).Methods:A total of 329 patients (331 lesions) who underwent ESD at Nanjing Drum Tower Hospital from October 2014 to December 2019 and were pathologically confirmed as differentiated early cardia cancer were included in the study and followed up. The endoscopic and pathological data of patients were reviewed to analyze the clinicopathological characteristics of differentiated early cardia cancer. The short-term (including en bloc resection rate, curative resection rate and incidence of short-term complications) and long-term efficacy (including incidence of metachronous cancer, recurrence and distant metastasis, and overall survival rate) of ESD was evaluated.Results:The ratio of male to female in 329 patients with differentiated early cardia cancer was 4∶1, and their age was 65.69±8.02 years. Tumor diameter of ≤2.0 cm accounted for 65.9% (218/331). Most lesions were located on the posterior wall (50.5%, 167/331), followed by the minor curve (36.3%, 120/331). The endoscopic morphology of 0-Ⅱc type accounted for 49.5% (164/331). There were 69.8% (231/331) lesions confined to the mucosal layer. The en bloc resection rate was 100.0% (329/329), and the curative resection rate was 83.3% (274/329). Short-term complications occurred in 28 patients (8.5%). With a median follow-up time of 39 months, 11 patients (3.3%) developed metachronous cancer, 2 (0.6%) developed distant metastasis, and no recurrence occurred. Seven patients died, and the overall survival rate during the follow-up period was 97.9% (322/329). The survival rate of patients with curative resection and additional surgery was 100.0% (3/3), while that without additional surgery was 99.3% (269/271). The survival rate of patients with non-curative resection and additional surgery was 96.0% (24/25), and that without additional surgery was 86.7% (26/30).Conclusion:Most differentiated early cardia cancers are well-differentiated adenocarcinomas, with less than 2 cm in diameter at the time of diagnosis with a low rate of ulcer and vascular invasion. ESD is safe and effective for the treatment of differentiated early cardia cancer with a high rate of curative resection, fewer intraoperative and postoperative complications, low incidences of metachronous cancer, distant metastasis and recurrence, and a high overall survival rate. However, additional surgical treatment is recommended for patients with non-curative resection.
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Objective To investigate the effect of different operative approaches on perioperative respiratory and cardiac function of patients with gastric cardia carcinoma. Methods The perioperative changes of SpO2 ,Breath Rate (BR) and Heart Rate(HR) of patients with gastric cardia carcinoma underwent surgical therapies through transthoracic ( n = 30 ), transabdominal ( n = 37 ) or trans-thoracoabdominal ( n = 10 )approaches were compared respectively. Results On the postoperative 1st,2nd,4th and 7th day,the changes of BR in transthoracic (5. 20 ± 0. 96,5. 17 ± 1. 58,3.93 ± 1.53,2. 63 ± 1.25 )/min and trans-thoracoabdominal (5.80 ±0. 79,6. 10 ± 1.20,4. 80 ± 1.32,3.00 ± 1.49)/min approach groups were significantly greater than that of transabdominal group (4. 35 ± 1.06,3.89 ±0. 99,2. 24 ± 1.30,1.16 ±0. 65)/min (Ps ＜0. 05). At the meanwhile, the changes of SpO2 at 2nd, 4th postoperative day of transthoracic ( [ 8. 30 ± 1.95 ] %, [ 7.23 ±2. 01 ] % ) and trans-thoracoabdominal ( [ 8.60 ± 1.43 ] %, [ 7. 70 ± 2. 11 ] % ) approach groups were significantly greater than that of transabdominal group ( [ 7. 08 ± 1.82 ] %, [ 6.24 ± 1.88 ] % ) ( Ps ＜ 0. 05 ), but there were no significant differences observed among three groups on the postoperative 1st,7th day. On the postoperative 1 st,2nd and 4th day, the changes of HR of transthoracic ( 18.00 ± 3.79,13.47 ± 4. 42,8. 60 ±4. 13 )/min and trans-thoracoabdominal ( 19. 80 ± 4. 96,14. 80 ± 3.33,8.70 ± 3.47)/min approach groups were significantly greater than that of transabdominal group ( 13.62 ± 4. 00,10. 84 ± 4. 16,6. 32 ± 2. 53 )/min, too (Ps ＜0. 05) ,but no differences were observed among three groups on the postoperative 7th day (Ps ＞0. 05).Coniclusion Transthoracic,transabdominal and trans-thoracoabdominal approachs resulted in different effects on respiratory and cardiac function in patients with gastric cardia carcinoma.
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Objective To investigate forte and technique in radical correction of gastric eardia carcinoma (esophagojejunostomy and gastric stump esophago anastomosis). Methods 753 Patients with gastric cardia carcinoma admitted to our hospital from 1998 to 2007 treated with radical correction by jejuno-osophagus an-astomosis and esophagogastric anastomosis to digestive tract reconstruction, circular staplers were used in all cases. Results There was no death (no leakage、bleeding and stricture of anastornotic entrance stenosis)in these cases by thoracoabdominal approach 6 cases, anastomotic leakage 0 case, pero-eutting 2 cases, steno-sis 4 cases, infection of abdominal cavity 1 case, diaphragmatic hernia 1 case, pathologic diagnosis of exam-ple after operation , the upper cut positive 1 case, the lower cut negative in all cases. Conclusions in rad-ical correction gastric cardia carcinoma, the application of circular stapler makes this procedure simple, reli-ability, safety and time saving, descends the ratio of radical correction of gastric cardia carcinoma by thora-coabdominal approach, decreases surgical trauma, decurtate the period of recovery following an illness, pre-vent the complications of post-operation such as the leakage and stricture of anastomotic entrance. But the applieation of circular stapler is not absolutely trustworthy, there are also any ratio of leakage ,haemorrhage and stricture of anastomotic entrance, the technique worth summarizing and investgating in the future.
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Objective To explore the relationship between the amount of CD3+ T cells in gastric cardia carcinoma(GCC)samples and the clinical pathological index of GCC.Methods Immunohistochemical Elivision method was used to detect CD3+T cells in 42 cases of GCC samples,18 cases of paraneoplastic tissue and 12 cases of normal cardiac mucosa tissue.The relationship between CD3+ T cell and the clinical pathological index was analysed.Results(1)The order of the mean number of CD3+ T cells from high to low was paraneoplastic tissue,GCC and normal mucosa(P0.05).(3)The mean number of CD3+ T cells was negatively correlated with the depth of carcinoma invasion and the lymphatic metastisis(P
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Objective To study the pathogenesis, clinical symptoms, surgical treatment and preventive measures of esophagogastric-arterial fistula following resection for carcinoma of the esophagus and cardia. Methods The clinical data of 18 patients with esophagogastric-arterial fistula were retrospective analyzed. Results There were 14 patients of esophageal carcinoma and 4 patients of cardiac carcinoma.7 patients had supra-aortic esophagogastric anastomosis(2 near the apex of pleura) and 11 had anastomosis under the aortic arch. Fatal hemorrhage occurred postoperatively from 11 to 93 days. The interval between hemorrhage and death varied from being instant to 18 days.All patients died. Conclusion The surgical treatment provide an opportunity for those patients. Successful management is possible if early diagnosis is made and prompt surgical management is undertaken. Preventive measures of peptic ulcer and esophageal fistula can decrease occurrence of this complication.
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Objective To observe the gallstone formation after radical operation for carcinoma of esophagus or cardia.Mothods From January 1993 to January 1998, 320 cases of radical operation for esophageal or cardiac cancers and 350 cases of non-operation were on dynamic observation in clinical practices. Results The postoperative galladder volume was much larger than that of preoperation and aslo much larger than that of non-operation patients(P
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Objective To determine whether Cox-2 inhibitor can reduce the risk of cardia carcinoma. Methods Paraffin-embedded specimens from 48 patients with esophageal, gastric or cardia carcinomas were analyzed by immunohistochemistry for expression of Cox-2 protein. Expression of Cox-2mRNA was assessed by RT-PCR and ISPCR in 29 cases of them. None of these patients were currently taking NSAIDs or glucocorticoid. Results The staining scores were 4.15?1.9 in the group with esophageal cancer, 3.66?1.16 in the group with gastric cancer, and 2.93?1.03 in the group with cardia cancer, respectively. There was no significant difference between groups of gastric cancer and cardia cancer. The ratio of cases with positive expression of Cox-2 mRNA was 87.5% in the group with cardia carcinoma, 100% in the group with esophageal cancer and the group with gastric cancer. And no significant difference was found between them. Cox-2mRNA was mainly located in cytoplasm but was found in nuclear too. No difference was found in the location of Cox-2 expression in the three kinds of cancers. Conclusion Cox-2 expression in cardia carcinoma was higher than in the normal group. Its pathological characteristics were almost the same as those in gastric and esophageal cancers. Cox-2 inhibitor possibly have a chemopreventive effect on cardia carcinoma.