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Objective: To investigate characteristics of celiac trunk lymph-node metastases of thoracic esophageal carcinoma and cardiac cancer and their influence on the prognosis, and to investigate a reason-able range for regional celiac trunk lymph-node clearance. Methods: Specimens from 836 patients treated with resection of thoracic esophageal carcinoma and cardiac cancer were retrospectively analyzed. Results:The rate of celiac lymph-node metastasis was 60.3% (502/836). Of the lymph nodes detected, 16.8% were found with metastasis. The extent of metastasis adjacent to the common hepatic artery and celiac trunk and within the hepatoduodenal ligaments was 10.8%, 10.1% and 9.8%, respectively. The overall rate of regional celiac recurrence at 3 years after surgery was 6.1%. The 3-year survival for patients with metastases in the celiac lymph nodes was 44.6%, lower than that in non-metastatic patients (72.4%) (P<0.05). Conclusion: Celi-ac lymph-node metastasis is one of key factors affecting the prognosis of patients treated with resection of esophageal cancer and cardiac cancer. Extensive clearance of the celiac-trunk lymph nodes can reduce the rate of postoperative regional metastasis.
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Objective To analyse the dysfunction of immunity and clinical significance in patients with cardiac cancer.Methods The level of CD4+ CD25hi CD127low Treg cells were detected by flow cytometry (FCM),and serum IL-10 and TGF-β1 levels were determined by enzyme linked immunosorbent assay (ELISA) kit in 56 patients with cardiac cancer.15 healthy volunteers were tested as normal controls.The clinical data of each patient were collected and analyzed. Results There was a significantly higher percentage of CD4+ CD25hi CD127low Treg cells in patients with cardiac cancer (5.73±1.56)% than that (4.45±1.06)% of healthy volunteers (P<0.01).The IL-10 and TGF-β1 levels in the serum of patients with cardiac cancer were also significantly higher than that of healthy volunteers (P<0.05).There was a positive correlation between levels of IL-10.TGF-β1 and the levels of CD4+ CD25hi CD127low Treg cells.The number of CD4+ CD25hi CD127low regulatory T cells in the peripheral blood of cardiac cancer patients were significantly correlated with clinical stages and metastasis lymph node.Conclusion The CD4+ CD25hi CD127low Treg cells in the peripheral blood of cardiac cancer patients is significantly increased in comparison with that in healthy volunteers,and was also correlated with different stages.The abnormal levels of CD4+ CD25hi CD127low Treg cells may be related to tumor progression in patients with cardiac cancer.
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Objective To explore the cause of anastomotie fistula after esophagus cancer and cardiac cancer operation and its prevention and treatment.Methods After excising the tumors,the esophagogastrostomy was performed in 60 cases,in which the cervical anastomose in 48 cases and intrathoracic anastomose was adopted in 12 cases.We retrospectively analyzed its prevention and treatment. Results Caevial anastomose in 48 cases,4 patients with anastomotic fistula in the died,while none of 12 cases in the cervical anastomose died. Conclusions Careful procedure and improving the anastomotic methods are the key factors to reduse the anastomotic fistula,the accurate control of infection and full nutritive support are the effective methods to decrease the mortality rate of this disease.
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Objective To explore the relationship between expression of MDR1 gene in human esophageal and cardiac cancer and clinicopathological changes. Methods From Jan 2 000 to Dec 2001, a total of 161 patients with esophageal or cardiac carcinoma were recruited, and MDR1 were assayed by RT-PCR. Fresh tumor tissues were surgically resected without chemotherapy before operation. Results The positive rate of MDR1 was 34.78 % (56/161). Among them 5 cm 38.54 %, invasion to muscular layer 30.77 %, invasion to tunica serosa 35.14 %, squamous cell carcinoma 27.27 %, adenocarcinoma 41.67 %, lymphonode metastasis positive 35.19 %, negative 33.96 %, stage Ⅰ,Ⅱ 33.33 %, stage Ⅲ, Ⅳ 35.58 %. The correlation between MDR1 expression and the age and sex of patients, Tumor size depth of invasion histologic types lymph node involvement and TNM, was not significant. Conclusion Because of highly expressive level of MDR1 gene in untreated esophageal and cardiac carcinoma, we should choose appropriate chemotherapeutic regimen for esophageal and cardiac cancer. The expression of MDR1 gene in untreated cancer was independented of morphologic prognostic indexes without correlation between MDR1 gene expression and morphological indexes.
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Objective: To sum up the therapeutic effect of early enteral nutrition(EN) in postoperative patients with esophageal or cardiac cancer.Methods: The clinical data of 106 postoperative patients with esophageal or cardiac cancer who had received early enteral nutrition treatment were analyzed retrospectively.Results: All the patients recovered well.The occurrence of the serious postoperative complication,such as anastomotic leak,hypoalbuminemia and so on had been decreased.Conclusion: Early EN for postoperative patients with esophageal or cardiac cancer is a physiological nutrition support way.EN can maintain gastrointestinal function and improve nutritional status.
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Objective To investigate the clinical epidemiological characteristic of the cancer in upper digestive tract detected by endoscopy and pathologically diagnosed in Xi'an.Methods Patients with cancer of upper digestive tract,detected by endoscopy and pathologically diagnosed from 1991.1 to 2002.12 were selected.The main clinical data,epidemiologyical,endoscopic manifestation and the pathological characteristics were studied.Results The overall diagnosis rate of upper digestive tract cancer was 8.13% in 12 years.Of all the patients who underwent endoscopy,cancer of esophagus,cardia,stomach and duodenum was 3.42%,1.44%,3.26% and(0.01%),respectively.Although the incidences of esophageal cancer and gastric cancer fluctuated,they showed remarkable decreasing tendency(P=0.000).Meanwhile,the incidence of cardiac adenocarcinoma increased slightly(P=0.000).The male/female ratio of cardiac cancer is 6.29∶1,which is much higher than that of esophageal cancer and gastric cancer(P=0.000).The ratio of squamous cell cancer and adenocarcinoma in esophagus didn't chang in 12 years((P=0.562)),and the adenocarcinoma of esophagus did not show any remarkable tendency (P=0.557).Conclusion Esophageal cancer is the most frequent cancer of upper digestive tract in Xi'an.The detection rate of esophageal cancer and gastric cancer has decreased respectively,and cardiac cancer has increased.Cardiac cancer is different from either esophageal or gastric cancer.
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Objective To compare the diagnostic accuracy of magnetic resonance (MR) images with multislice computer tomography (MSCT) for preoperative T-staging of patients with cardiac cancer. Methods MR and MSCT were performed in 28 cases of cardiac cancer diagnosed by biopsy prior to operation within one week. After an oral intake of 1000 ml water and an injection of hypotonic agent, MR and MSCT scan were carried out. MR sequences included FSE T1W, FSE T2W, FSE T1W with fat suppression and dynamic enhanced FSPGR with fat suppression. MSCT was applied with dynamic triphasic contrast enhancement. All of the findings were prospectively analyzed by two doctors separately and compared with the surgical and pathological findings. Results According to histopathologic staging, the accuracy of MR and MSCT in T1-staging were 88.8% and 11.1%, in T2-staging were 77.8% and 22.2%, in T3-staging were 83.3% and 32.7%, in T4-staging were 100.0% and 50.0%, respectively. Dynamic enhanced and delayed MR with fat suppression was superior to MSCT for revealing the involvement of esophagus and aorta, early stage of invasiveness and providing more evidences in T2 to T3 or T3 to T4 staging (P
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Objective To evaluate clinical features and the clinical application of radical transabdominal operation for the senile cardiac cancer by using the EEA(end-to-end anastomosis) stapler.Methods 80 senile patients underwent curative intent due to cardic cancer from 1991 to 2001,and the clinical effects of transabdominal operation for cardiac carcinoma by using the EEA stapler were investigated retrospectively.Results The average age of the patients was 70-year old, and the ratio of men to women was 5∶1. The average course of the disease was 3 2 months. Only 2 5% of the patients got early diagnosis, and the rate of the preoperative complications was 60%. Patients were treated by radical transabdominal operation by using stapler, and the rates of radical dissection and palliative dissection were 71 3% and 18 8% respectively. The incidence of postoperative complication was 5%, and the in-patient mortality was 1 25%, and the above indexes were significantly lower than those in the trans-thoracicoabdominal approach. The 5-year survival rate was 20% after gastrectomy.Conclusions This study showed that the approach exerted little effect on the respiratory and circulatory systems, and it could decrease the surgical risk and the incidence of diverse complications.
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Objective To evaluate the effectiveness of preoperative perfusion chemotherapy via left gastric artery catheterization in patients with cardiac cancer of the stomach.Methods 56 operated cases with cardiac cancer,who had undergone preoperative perfusion chemotherapy via left gastric artery,were collected and analyzed.Results Most of the tumors were hypervascular as studied with DSA.After perfusion chemotherapy,there was amelioration of symptoms.Decrease in size about 50% of the tumor mass,shown in barium study were found in 32 patients,(18% of them).The survival rates one year,two years and three years after surgical resection were 98%,78.6% and 53.6% respectively.18 cases(32%)had gastric hemorrage,that was the main complication after perfusion.Conclusion Preoperative perfusion chemotherapy via left gastric artery in cases with cardiac cancer of the stomach is an effective measure in increasing resection rates in surgery.
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Objective To evaluate the effect of transarterial chemoembolization (TACE) before operation, including side effects and the improvment for the suceesfult resection rate.Methods 56 patients with cardiac cancer were divided into two groups: TACE group and resection group. The former included 25 patients (male 14, female 11) undertaken TACE 7-15 days before surgery. The image manifestations, histological changes and side effects together with the time of operation, volume of blood lose during operation and the succesful resection rate were compared with those of the latter. Results 1. TACE induced the necrosis of tumor tissue to some extent and possessed the power to localize the lesion with little side effects. 2. TACE before resection did not only minimize the injury of operation but also improved the resection rate. Conclusion TACE is a safe, effective modality before operation and is worthy for recommendation