Resultados de la cirugía conservadora y radical de la mama en pacientes operadas en el Centro de Investigaciones Médico Quirúrgicas, Cuba / Results of Conservative or Radical Breast Surgeries in Patients Operated on at Centro de Investigaciones Médico Quirúrgicas, Cuba

Introducción: El cáncer ha causado más muertes que todas las guerras y catástrofes conocidas. En particular, el cáncer de mama se ha convertido en una pandemia que amenaza con seguir propagándose. Objetivo: Describir las diferencias en cuanto a los resultados obtenidos de la cirugía conservadora y radical como tratamiento del cáncer de mama. Métodos: Se realizó un estudio analítico, observacional, descriptivo y retrospectivo en un universo de 177 pacientes con diagnóstico de cáncer de mama en el servicio de Cirugía General del Centro de Investigaciones Médico Quirúrgicas de La Habana, Cuba. Todas recibieron tratamiento quirúrgico en el período comprendido de enero de 2011 a diciembre de 2016. Resultados: De las pacientes estudiadas, el 92,09 por ciento no presentaron antecedentes de patología mamaria, mientras que el 36,72 por ciento tuvieron como antecedente patológico familiar cáncer de mama. Predominaron las pacientes mayores de 70 años en ambas técnicas quirúrgicas. En el grupo de 30-40 años solamente se practicaron técnicas conservadoras. Con respecto al estadiamiento, predominó la etapa II de la enfermedad. La sobrevida global a los 5 años fue superior al 90 por ciento, mientras que el intervalo libre de enfermedad se mantuvo en valores similares para ambas técnicas. Conclusiones: Se realizaron mayor número de cirugías conservadoras de mama en pacientes que se encontraban en etapas clínicas más tempranas de la enfermedad y la sobrevida global de los procedimientos conservadores fue ligeramente mayor(AU)

Introduction: Cancer has caused more deaths than all known wars and catastrophes. Particularly speaking, breast cancer has become a pandemic that threatens to continue to spread. Objective: To describe the differences based on the results obtained from conservative and radical surgery as a treatment for breast cancer. Methods: An analytical, observational, descriptive and retrospective study was carried out with a universe of 177 female patients diagnosed with breast cancer in the general surgery service of Centro de Investigaciones Médico Quirúrgicas, of La Habana, Cuba. All of them received surgical treatment in the period from January 2011 to December 2016. Results: 92.09 percent of the patients studied had no history of breast pathology, while 36.72 percent had breast cancer as a family pathological history. Patients over 70 years of age predominated in both surgical techniques. In the group of 30-40 years of age only conservative techniques were performed. With respect to staging, there was a predominance of the disease in stage II. Overall survival at 5 years was higher than 90 percent, while the disease-free interval remained at similar values for both techniques. Conclusions: A greater amount of breast-conserving surgeries were performed in patients at earlier clinical stages of the disease, while overall survival of conservative procedures was slightly higher(AU)

Clinical application of optical surface monitoring system in radiotherapy after radical mastectomy for left breast cancer / 中国辐射卫生

@#<b>Objective</b> To study the setup error under deep inspiration breath hold (DIBH) guided by optical surface monitoring system (OSMS) and free breathing (FB) FB1 and FB2 (without OSMS guidance, directly set up the body marker line by laser lamp) in radiotherapy after radical mastectomy for left breast cancer, and to provide a basis for individualized clinical target volume-planning target volume (CTV-PTV) expansion for the doctor in charge to delineate the target volume. <b>Methods</b> A total of 36 patients with left breast cancer after radical mastectomy were selected and divided into three groups, in which cone beam computed tomography (CBCT) images were taken in three states: DIBH, FB1, and FB2, respectively. CBCT and CT images were analyzed for registration; the absolute error data of linear displacement in the ventro-dorsal, cranio-caudal, and left-right directions were recorded, and the expanding margin was calculated. <b>Results</b> The translation errors in the ventro-dorsal, cranio-caudal, and left-right directions were (0.06 ± 0.22) cm, (0.05 ± 0.23) cm, and (0.01 ± 0.24) cm in the DIBH group, (0.07 ± 0.21) cm, (0.02 ± 0.23) cm, and (0.02 ± 0.21) cm in the FB1 group, and (0.07 ± 0.24) cm, (0.07 ± 0.34) cm, and (0.25 ± 0.09) cm in the FB2 group. The statistical results of the DIBH group and FB1 group in the ventro-dorsal, RTN, and ROLL directions were significantly different (<i>P</i> < 0.05). The statistical results of the FB1 group and FB2 group in the ventro-dorsal direction were significantly different. The relation of three groups in the value of margin of planning target volume was DIBH < FB1 < FB2 in the ventro-dorsal and cranio-caudal directions and FB1 < DIBH < FB2 in the left-right direction. <b>Conclusion</b> OSMS-guided DIBH radiotherapy in patients with left breast cancer after radical mastectomy can reduce the setup error and provide an important basis for individualized CTV-PTV expansion for the doctor in charge to delineate the target volume.

Clinical features and optimal treatment of primary urethral carcinoma / 现代泌尿外科杂志

【Objective】 To explore the clinical features and treatment outcomes of female urethral carcinoma so as to improve the awareness and prognosis of this rare malignant disease. 【Methods】 Clinical data of 8 cases of female urethral carcinoma treated during Jan. 2012 to Dec.2022 at the Department of Urology of Peking University People’s Hospital were retrospectively analyzed. The patients underwent urodynamic tests, cystourethroscopy and pathological biopsy to confirm the diagnosis. Traditional radical surgery was performed in 5 cases, and radical surgery for lower urethral cancer with bladder preservation was performed in 3 cases. 【Results】 The patients aged 36 to 68 years, with a mean of 53.75 years. Urinary obstruction, lower urinary tract symptoms and urethral masses were common manifestations. Urodynamic tests indicated bladder outlet obstruction. After surgical treatment, radical surgery for lower urethral cancer with bladder preservation showed advantages over traditional radical surgery in terms of intraoperative bleeding, operation time and postoperative hospital stay. 【Conclusion】 Female primary urethral carcinoma is rare but invasive. Early diagnosis and radical surgery are crucial for improving the prognosis. Radical surgery for lower urethral cancer with bladder preservation has better treatment outcomes and postoperative quality of life compared to traditional radical surgery. For such patients, symptoms should be closely monitored and timely diagnosis and treatment should be performed.

Influencing factors of anxiety and depression in patients with secondary lower extremity deep venous thrombosis after radical cervical cancer surgery / 中华健康管理学杂志

Objective:To investigate the influencing factors of anxiety and depression in patients with secondary lower extremity deep venous thrombosis (LEDVT) after radical cervical cancer surgery.Methods:Retrospective analysis method was used, a total of 92 patients with anxiety and/or depression secondary to LEDVT after radical cervical cancer surgery admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region from June 2019 to June 2022 were included as the observation group, according to the presence of anxiety or depression, they were divided into anxiety group (65 cases) and depression group (58 cases) (some patients had both anxiety and depression). Another 90 patients who did not have anxiety or depression after radical cervical cancer surgery with secondary LEDVT were selected as the control group in the same period. The questionnaires of clinical data and disease cognition were designed to investigate the clinical data and disease cognition of patients, social support rating scale (SSRS) was used to assess the level of social support of patients, and univariate analysis was performed to identify the influencing factors of depression and anxiety in patients with secondary LEDVT after radical cervical cancer surgery.Results:The percentage of patients with self-pay, no children, unemployed or jobless, monthly family income <5 000 CNY, less social support, and disease awareness <80 scores in the anxiety group and depression group (36.92%, 67.69%, 69.23%, 66.15%, 46.15%, 70.77% and 34.48%, 68.97%, 72.41%, 65.52%, 44.83%, 68.97%) were higher than the control group (14.44%, 40.00%, 33.33%, 32.22%, 11.11%, 23.33%) (all P<0.01). The percentage of mixed thrombus, central thrombus, peripheral thrombus, bilateral thrombus, right thrombus, and left thrombus in the anxiety group and depression group (30.77%, 20.00%, 49.23%, 16.92%, 35.38%, 47.69% and 32.76%, 15.52%, 51.72%, 12.07%, 37.93%, 50.00%) were not significantly different from those in the control group (32.22%, 17.78%, 50.00%, 10.00%, 36.67%, 53.33%) (all P>0.05). Univariate analysis showed that self-pay, unemployed or jobless, no children, monthly family income <5 000 CNY, less social support, and disease awareness <80 scores were correlated with depression and anxiety status in patients with secondary LEDVT after radical cervical cancer surgery (all P<0.01). Conclusion:Depression and anxiety in patients with secondary LEDVT after radical cervical cancer surgery are related to self-pay, unemployed or jobless, no children, low monthly family income, less social support, and low disease awareness.

Value of fertility-sparing surgery for young females with epithelial ovarian cancer: a comparative study / Valor de la cirugía de preservación de la fertilidad en mujeres jóvenes con cáncer de ovario epitelial: un estudio comparativo

Resumen OBJETIVO: Comparar la cirugía radical con la cirugía conservadora de la fertilidad en mujeres con cáncer de ovario epitelial en estadio 1A-C con respecto a la tasa de recurrencia y las tasas de supervivencia. Además, evaluar los desenlaces reproductivos y obstétricos para las mujeres con cáncer de ovario epitelial en estadio I tratadas con una conducta conservadora de la fertilidad. PACIENTES Y MÉTODOS: Estudio prospectivo efectuado en pacientes con cáncer de ovario epitelial, estadio I, con edad ≤ 40 años. A las pacientes del grupo de preservación de la fertilidad se les practicó salpingooforectomía del lado del ovario afectado y una biopsia por incisión o escisión en cuña del ovario contralateral. A las pacientes del grupo de cirugía radical se les practicó la histerectomía total y salpingooforectomía bilateral. Para evaluar los desenlaces reproductivos y oncológicos se dio seguimiento a todas las pacientes durante cinco años. RESULTADOS: Se estudiaron 60 pacientes; las del grupo de cirugía de preservación de la fertilidad eran significativamente más jóvenes (30 ± 4 en comparación con 35 ± 5) (p < 0.001), el tamaño de sus tumores era más pequeño 3.4 ± 1.3 en comparación con 6.0 ± 2,6 (p < 0.001), de menor grado (p < 0.001). = 0.011), estadio más precoz (p < 0.001) y con más histología mucinosa que las pacientes del grupo de cirugía radical. No hubo diferencias estadísticamente significativas entre ambos grupos en cuanto a la recurrencia tumoral o las tasas de supervivencia. De 25 pacientes operadas para preservación de la fertilidad 18 de 25 intentaron quedar embarazadas. Se registraron 15 de 18 embarazos, incluidos 13 nacidos vivos, 1 aborto espontáneo y 1 muerte fetal intrauterina. CONCLUSIÓN: La cirugía conservadora de la fertilidad podría ser una alternativa adecuada a la cirugía radical para mujeres jóvenes con cáncer epitelial de ovario en estadio I.

Abstract OBJECTIVE: In the current study, we aimed to compare between radical surgery and fertility saving surgery in females with stage 1A-C EOC regarding recurrence rate and patients survival rates in addition to evaluating reproductive and obstetric outcomes for stage I EOC females who were managed by fertility saving surgery. PATIENTS AND METHODS: We prospectively identified 60 patients diagnosed with stage I EOC aged ≤ 40 years. Patients in the fertility-preservation group underwent salpingo-oophorectomy on the side of the affected ovary in addition to incisional biopsy or wedge excision of the ovary on the other side. Patients in the radical surgery group underwent total hysterectomy and bilateral salpingo-oophorectomy. We followed up all patients for 5 years to assess their reproductive and oncological outcomes. RESULTS: Patients in the fertility preservation surgery group were significantly younger (30 ± 4 versus 35 ± 5) (p < 0.001), their tumor sizes were smaller 3.4 ± 1.3 versus 6.0 ± 2.6 (p < 0.001), of lower grade (p = 0.011), earlier stage (p < 0.001) and has more mucinous histology than patients in the radical surgery group. There were no statistically significant differences between both groups regarding tumor recurrence or survival rates. Of 25 patients underwent fertility preservation surgery, 18/25 (72%) tried to get pregnant. 15/18 (83%) pregnancies were recorded, including 13 live births, 1 miscarriage, and 1 intrauterine fetal death. CONCLUSION: Fertility sparing surgery could be adequate alternative to radical surgery for young females with stage I EOC.

Multiple primary carcinoma of esophagus and lung: A case report / 中国胸心血管外科临床杂志

@#Nowadays, the popularization of endoscopic technology makes a substantial increase in the diagnosis rate of esophageal multiple primary carcinoma. However, the multiple primary carcinoma combined with esophageal cancer, lung cancer and cardiac cancer is relatively rare. This paper reported a 64-year-old male with multiple primary cancer who received one-stage complex radical surgery, including radical resection of esophageal cancer, lung cancer and cardiac cancer. After the operation, the patient presented chylothorax and conservative treatment was ineffective. Then we preformed ligation of thoracic duct through single-portal thoracoscope. The patient recovered successfully after surgery and the follow-up results showed well.

Application Value of ctDNA-based MRD Dedection in Early Stage Non-small Cell Lung Cancer after Radical Surgery / 中国肺癌杂志

Lung cancer is the most common malignant tumor in the world, among which non-small cell lung cancer (NSCLC) accounts for about 85% of the total number of lung cancers. The 5-year overall survial (OS) of radical surgery NSCLC patients ranged from 92% in stage Ia1 to 26% in stage IIIb, and the continuously decreasing survival time made it a strong clinical need for precise adjuvant therapy to eradicate molecular residual disease (MRD). At present, circulating tumor DNA (ctDNA) as a molecular indicator of MRD has gradually moved from the laboratory to the clinic. The latest consensus proposes that ctDNA with abundance ≥0.02% can be stably detected in the peripheral blood of perioperative NSCLC patients, which is based on the possibility of ctDNA as an MRD indicator. MRD detection technology supports the possibility of monitoring after radical treatment of NSCLC, and ctDNA can predict the recurrence of the disease earlier than the imaging monitoring after treatment of NSCLC, providing valuable time for timely adjustment of adjuvant therapy. In the studies on early postoperative adjuvant therapy of NSCLC, different guidelines differ on whether appropriate adjuvant therapy should be carried out, while MRD can be used as a more accurate predictor to guide postoperative adjuvant therapy, so that patients can benefit from the disease treatment.
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da Vinci robot system for radical surgery of lung cancer in elderly patients / 中国胸心血管外科临床杂志

@#Objective    To evaluate the feasibility and safety of da Vinci robotic surgery for elderly patients with radical surgery of lung cancer. Methods    We retrospectively analyzed the clinical data of 59 patients aged over 70 years who underwent radical surgery of lung cancer in our hospital between 2016 and 2019. These patients were divided into two groups including a da Vinci robot group and a single-utility port video-assisted thoracoscopic surgery (VATS) group according to the patients’ selection of the treatments. There were 32 patients with 20 males and 12 females aged 73.1±2.3 years in the da Vinci robot group and 27 patients with 16 males and 11 females aged 71.2±1.3 years in the VATS group. The clinical data of the two groups were compared. Results    There was no statistical difference in surgery time between the two groups (t=–0.341, P=0.484). Compared with the VATS group, the da Vinci robot group had more number of lymph nodes dissected (t=1.635, P=0.015), less intraoperative blood loss (t=–2.569, P <0.001), less postoperative drainage amount within 3 days after surgery (t=–6.325, P=0.045), lower visual analogue scale (VAS) scores at postoperative 3rd day (t=–7.214, P=0.021). Conclusion    The da Vinci robot system is safe and efficient in the treatment for elderly patients with radical surgery of lung cancer with less trauma.

Effect of preoperative Nutritional Risk Screening-2002 combined with hematologic inflammatory markers on prognosis of thoracic esophageal squamous cell carcinoma / 中华肿瘤杂志

Objective@#To evaluate preoperative nutritional status and inflammatory status by Nutritional Risk Screening-2002 (NRS-2002) and hematologic inflammatory markers in patients with thoracic esophageal squamous cell carcinoma (ESCC), and to explore their effects on long-term survival prognosis.@*Methods@#A total of 113 patients with thoracic ESCC treated by radical resection were grouped for further analysis according to preoperative NRS-2002 score, systemic inflammation score (SIS) and the combination of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (CNP) score. The progression free survival (PFS) and overall survival (OS) between groups were compared. Multivariate Cox regression analysis was used to determine the independent prognostic factors of patients with thoracic esophageal squamous cell carcinoma, and the interaction analysis of statistically significant factors was carried out.@*Results@#The median PFS was 21 months for all the patients. The 1-year, 3-year and 5-year PFS rates were 69.0%, 25.7% and 23.1%, respectively. Correspondingly, the median OS was 36 months, and the 1-year, 3-year and 5-year OS rates were 95.6%, 46.2% and 29.2%, respectively. Cox univariate analysis showed that T stage, N stage, TNM stage, SIS, CNP score and NRS-2002 score were significantly associated with PFS and OS (all P<0.05), and sex was associated with PFS (P=0.032) in patients with thoracic ESCC. Furthermore, cox multivariate analysis showed that TNM stage (HR=1.570, P=0.039), NRS-2002 score (HR=2.706, P<0.001) and CNP score (HR=1.463, P=0.011) were independent prognosis factors of PFS in patients with thoracic ESCC. In cox model interaction analysis, there was a positive interaction between NRS-2002 score and CNP score (RR=2.789, P<0.001).@*Conclusion@#Preoperative NRS-2002 score combined with CNP score are risk factors for prognosis of patients with thoracic ESCC, which can be used as prognostic indicators.

Concept and clinical application of surgical margin principle on head and neck cancers / 中华耳鼻咽喉头颈外科杂志

Surgical margin principle is one of the central surgical principles for head and neck cancers. Negative surgical margin is the primary purpose of surgery for head and neck cancers. This paper is based on the current clinical application of surgical margins of head and neck cancers, and it is proposed that surgical margins of head and neck cancers may be classified into three types: surface margin, deep margin, and tissue interface margin in consideration of surgical exposure of tumors. The classification of surgical margins can make the clinical application and the research of surgical margins of head and neck cancers more systematic and clear.

Multidisciplinary diagnosis and treatment of anastomotic leakage in esophageal cancer and its effect on prognosis / 医学研究生学报

Objective Early diagnosis and effective treatment are the key to reduce the mortality and improve the prognosis of anastomotic leakage which involved many disciplines after esophageal cancer surgery. The aim of the study is to investigate the value of multidisciplinary which combined diagnosis and treatments in anastomotic leakage after esophageal cancer operations. Methods A total of 82 patients with anastomotic leakage after esophageal cancer surgery in our hospital from June 2013 to June 2018 . 43 patients from June 2013 to December 2015 were included in the control group. 39 patients with anastomotic leakage from January 2016 to June 2018 were used as the observation group. Patients in the control group were given routine diagnosis and treatment, while the observation group was given a multidisciplinary (thoracic surgery, imaging, general surgery, nutrition,etc.) joint diagnosis and treatment model. Observe general data, prognosis, and fistula healing time. Results The proportion of occultation in the observation group was significantly higher than that in the control group(38.5% vs 18.6%), and the difference was statistically significant (P<0.05). The healing time of anastomotic leakage was lower in the observation group[(17.24±3.62)d] than in the control group[(33.85±4.85)d](P<0.05). Conclusion Multidisciplinary combined diagnosis and treatment can improve the incidence of occult sputum and reduce the healing time of anastomotic leakage. It is worthy of clinical promotion.

Controversy and countermeasure of treatment for locally advanced cervical carcinoma / 中国实用妇科与产科杂志

The choice of treatment in locally advanced cervical carcinoma is a hot topic in the controversy of treatment for gynecology tumor.The three primary therapies for locally advanced cervical carcinoma are concurrent chemotherapy and radiotherapy,direct radical hysterectomy and operation after radiotherapy.This article mainly discusses several types of treatment and advises personalized treatment for locally advanced cervical carcinoma.

Evaluation of modified Overlap method in digestive tract reconstruction after totally laparoscopic total gastrectomy for gastric cancer / 中国综合临床

Objective To evaluate the clinical effect of modified Overlap method in digestive tract reconstruction of totally laparoscopic total gastrectomy(TLTG) for gastric cancer??Methods The data of 86 patients with gastric cancer who underwent TLTG from January 2014 and January 2017 were collected from the First Hospital of Lanzhou University??All the patients underwent D2 lymphadenectomy??Forty?four patients′digestive tracts were reconstructed with traditional Overlap method (control group),and 42 patients′digestive tracts were reconstructed with modified Overlap method ( modified group )??The intraoperative and postoperative conditions, postoperative tumor?free survival, tumor recurrence and metastasis were compared between the two groups??Follow up lasted as of February 2018??Results TLTG was successfully performed in both groups,and no case was converted to laparotomy??The time of esophagojejunostomy ((20??4±2??3) min vs??(46??5±4??4) min, t＝9??493), total operation time (( 253??3 ± 12??8) min vs??( 278??6 ± 14??9) min,t＝5??462) in the modified group were significantly shorter than those in the control group,and there were significant differences between the two groups ( all P＜0??05)??And there were no significant differences between the the modified group and control group in volume of intraoperative blood loss(( 71??5±12??9) ml vs??(73??2± 15??3) ml , t＝0??286), number of lymph node dissected (( 35??5 ± 4??8) vs??( 34??2 ± 5??6) , t＝0??618),first postoperative exhaust time (( 2??6 ± 0??9) d vs??( 2??7 ± 1??1) d, t＝0??348), postoperative hospitalization time((9??9± 1??6) d vs??( 9??8 ± 1??7) d,t＝0??229) and postoperative complications( 7??1%(3／42) vs??9??1%(4／44), χ2 ＝ 0??207) ( all P＞0??05)??The two groups were followed up for 12～25 months??No recurrence or metastasis occurred??Conclusion Compared with traditional Overlap method,the modified Overlap method can simplify the anastomotic procedures, shorten operation time and achieve an effective and reliable anastomosis effect after TLTG??

Application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer / 中华消化外科杂志

Objective To investigate the application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer.Methods The retrospective and descriptive study was conducted.The clinical data of a 49-year-old male patient with esophageal cancer who was admitted to the Fujian Medical University Union Hospital in November 2018 were collected.The patient underwent closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection.In the thoracic part,esophageal separation and thoracic lymph node dissection were performed with closed pneumothorax,semi-lateral position and multi suspension methods.In the abdominal part,gastric separation and lymph node dissection were accomplished with lifting of liver lobe and respective separation of greater curvature and lesser curvature of stomach.The operation time,volume of intraoperative blood loss,time for out-of-bed activities,time of postoperative drainage tube removal,volume of thoracic drainage fluid,postoperative complications,postoperative pathological examination results,time for discharge from hospital and results of follow-up were observed.Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis of patients after operation up to February 2019.Count data were described as absolute number.Results The patient underwent successfully closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection.The operation time and volume of intraoperative blood loss was 310 minutes and 120 mL.The patient resumed out-of-bed activities at 2 days after operation.The abdominal drainage tube,thoracic closed drainage tube and right cervical drainage tube were removed at 2 days after operation with fasting,acid suppression,nutritional support.The thoracic Abel drainage tube and the left cervical drainage tube were removed at 5 days after operation.The volume of thoracic drainage fluid was 550 mL.No obvious sign of anastomotic leakage was found on esophageal angiography at 5 days after operation.The patient recovered well after operation without hoarseness,pulmonary infection and chylothorax.The postoperative examination result of the patient showed midthoracic esophageal squamous cell carcinoma (pT3N1M0G3 ⅢB stage).The patient was discharged at 8 days after operation.The patient was followed up for 3 months,and was able to engage in light physical activity.CT reexamination showed no sign of local recurrence or distant metastasis of the tumor.Conclusion Closed singleport thoracoscopic and laparoscopic radical esopahgectomy for esophageal cancer is safe and feasible,with good short-term efficacy.

Prognosis analysis of 338 rectal neuroendocrine neoplasms with maximum diameter of 1 cm to 2 cm / 中华消化杂志

Objective To analyze the clinical characteristics and prognostic factors of rectal neuroendocrine neoplasm (r-NEN) with the maximum diameter of 1 cm to 2 cm,and to provide a theoretical evidence for selection of resection method.Methods From 1988 to 2015,the data of patients pathologically diagnosed as r-NEN with the maximum diameter less than 2 cm were selected from American surveillance,epidemiology,and end results (SEER) database with SEER * Stat 8.3.5 software.According to the resection method,the patients were divided into local resection group and radical resection group.T test and chi-square test were performed to compare the clinicopathological features.Kaplan-Meier survival analysis and Cox multivariate analysis were used to analyze the prognostic factors analysis.Results The maximum diameter of tumors of 1 831 patients with r-NEN was less than 1 cm,and that of 338 patients with r-NEN was between 1 cm and 2 cm.There were significant differences between two groups in tumor grade,tumor stage,T stage,lymph node metastasis,distant metastasis and resection method (x2 =7.120,144.728,86.296,133.096,42.842 and 52.048,all P ＜ 0.05).The prognosis of the former was better than that of the latter (x2 =11.590,P =0.001).Among the patients with r-NEN with the maximum diameter of 1 cm to 2 cm,279 (82.5％) patients received local resection and 59 (17.5％) patients underwent radical surgery.Propensity score matching was used to pair the r-NEN patients with the maximum diameter of 1 cm to 2 cm who received different resection methods,and 41 pairs of cases were enrolled.The results of univariate analysis showed that age and tumor grade affected the survival prognosis of patients with r-NEN of the maximum diameter of 1 cm to 2 cm (x2 =6.837 and 10.852,P =0.009 and 0.004).The results of Cox multivariate analysis indicated that age was an independent prognostic factor of patients with r-NEN of the maximum diameter of 1 cm to 2 cm (hazard ratio (HR) =1.110,95％ confidence interval (CI) 1.040 to 1.184,P =0.002).Analysis of subgroups without lymph nodes or distant metastases demonstrated that age (HR =1.101,95％ CI 1.042 to 1.162,P =0.001) and resection method (HR =3.128,95％ CI 1.003 to 9.754,P =0.049) were the independent factors.Conclusions Age is an independent factor of patients with r-NEN of the maximum diameter of 1 cm to 2 cm.Among the patients without lymph nodes or distant metastasis the younger cases and those with local resection have better prognosis.

Analysis of technical difficulties of single-port and reduced port laparoscopic radical gastrectomy for gastric cancer / 中华消化外科杂志

Single-port and reduced-port laparoscopic radical gastrectomy as the innovative surgery for gastric cancer are gradually accepted nowadays,and more attentions are also paid to single-port and reduced-port laparoscopic radical gastrectomy due to its better cosmetic effect,less pain,lower incidence rate of surgical site infection and more advantages in enhanced recovery after surgery.However,in the early stage,the development of single-port and reduced-port laparoscopic radical gastrectomy were facing challenges and obstacles on account of limited surgical skills,the lack of special laparoscopic instruments,laparoscope and multi-port Trocar.In recent years,the dilemma and difficult situations were gradually resolved following by surgical techniques innovation,laparoscopic instruments and facilities improvement.It is believed that single-port and reduced-port laparoscopic radical gastrectomy will have a good prospect and breakthrough in the field of gastric cancer treatment in the future.

Survival Nomograms after Curative Neoadjuvant Chemotherapy and Radical Surgery for Stage IB2-IIIB Cervical Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to develop nomograms for predicting the probability of overall survival (OS) and progression-free survival (PFS) in locally advanced cervical cancer treated with neoadjuvant chemotherapy and radical surgery. MATERIALS AND METHODS: Nomograms to predict the 5-year OS rates and the 2-year PFS rates were constructed. Calibration plots were constructed, and concordance indices were calculated. Evaluated variableswere body mass index, age, tumor size, tumor histology, grading, lymphovascular space invasion, positive parametria, and positive lymph nodes. RESULTS: In total 245 patients with locally advanced cervical cancer who underwent neoadjuvant chemotherapy and radical surgery were included for the construction of the nomogram. The 5-year OS and PFS were 72.6% and 66%, respectively. Tumor size, grading, and parametria status affected the rate of OS, whereas tumor size and positive parametria were the main independent PFS prognostic factors. CONCLUSION: We constructed a nomogram based on clinicopathological features in order to predict 2-year PFS and 5-year OS in locally advanced cervical cancer primarily treated with neoadjuvant chemotherapy followed by radical surgery. This tool might be particularly helpful for assisting in the follow-up of cervical cancer patients who have not undergone concurrent chemoradiotherapy.

Oncological outcomes analysis of colorectal cancer with unfavorable histological features / 中华外科杂志

Objective@#To explore the effect of unfavorable histological features on the clinical outcomes of patients receiving radical resection of colorectal cancer.@*Methods@#A retrospective analysis of patients with colorectal cancer who received radical surgery between January 2013 and December 2015 at Department of General Surgery, Peking Union Medical College Hospital was performed. The impact of unfavorable histological features on the oncological outcomes of patients with lymph node-negative colorectal cancer were analyzed.A total of 167 patients were enrolled, including 98 males and 69 females with age of (63.6±11.6) years. Observation indicators included age, T stage, lymphovascular invasion, perineural invasion, tumor deposits, number of lymph node dissection, degree of differentiation, tissue type, and circumferential margin. Univariate analysis was performed with χ2 test and multivariate analysis was performed with Cox regression model.@*Results@#Univariate analysis showed that positive circumferential margins (CRM), tumor deposits and age were associated with disease free survival (DFS) rate; positive CRM, age, tumor deposits, and lymph nodes dissection less than 12 were significantly associated with overall survival (OS) rate (all P<0.05). Multivariate analysis showed that over 70 years of age (HR=1.053, 95% CI: 1.013 to 1.095, P=0.009), poorly differentiated adenocarcinoma (HR=7.572, 95%CI: 1.815 to 31.587, P=0.005), tumor deposits (HR=4.711, 95% CI: 1.809 to 12.264, P=0.002), mucinous adenocarcinoma (HR=3.063, 95% CI: 1.003 to 9.354, P=0.049), lymphovascular invasion (HR=2.885, 95% CI: 1.062 to 7.832, P=0.038), and nerve infiltration (HR=6.610, 95% CI: 1.037 to 42.122, P=0.046) were adverse prognostic factors of DFS rate; poorly differentiated adenocarcinoma (HR=12.200, 95% CI: 1.985 to 74.972, P=0.007), tumor nodules (HR=5.379, 95% CI: 1.636 to 17.685, P=0.006), over 70 years of age (HR=1.062, 95% CI: 1.013 to 1.114, P=0.013), and perineural invasion (HR=8.043, 95% CI: 1.026 to 63.055, P=0.047) were adverse prognostic factors of OS rate. There was no significant difference in the 3-year DFS rate and 3-year OS rate between T1-2 group and T3-4 group (P>0.05).@*Conclusion@#Over 70 years of age, poorly differentiated adenocarcinoma, mucinous adenocarcinoma, tumor nodules, lymphovascular invasion, and perineural invasion are independent adverse prognostic factors of lymph node-negative colorectal cancer.

Application of vascular replacement technique with allogenic blood vessel in radical resection for pancreatic carcinoma: a report of 33 cases / 中华外科杂志

Objective@#To analyze the application of vascular replacement technique with allogenic blood vessel in radical resection for pancreatic carcinoma.@*Methods@#The clinical data of 33 patients with vascular invasion of pancreatic carcinoma who underwent radical resection from April 2013 to April 2017 in Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital were retrospectively analyzed. There were 14 males and 19 females with age of (62.5±10.6)years(ranging from 35 to 78 years). Vascular replacement technique with allogenic blood vessel was used on all patients who underwent radical resection for pancreatic carcinoma. The operation procedure was made according to the specific location of the carcinoma, and the allogenic blood vessel was selected according to the type of vascular invasion. The matching vessel was selected for replacement to the patient who was invaded only one vessel. And the "Y" type of iliac vein was selected for replacement to the patient who was invaded the confluence of portal vein, splenic vein and superior mesenteric vein. After the operation, the patients were followed up by telephone and outpatient review.@*Results@#All of 33 patients were successfully completed the operations. There were 28 patients underwent pancreaticoduodenectomy with vascular replacement, and 5 patients underwent total pancreatectomy with vascular replacement. All the patients were confirmed pancreatic carcinoma and R0 resection according to the postoperative pathology. There were 16 patients with the carcinoma invasion the confluence of portal vein, splenic vein and superior mesenteric vein, 12 patients with the carcinoma invasion the superior mesenteric vein, and 5 patients with the carcinoma invasion the portal vein. There was no perioperative death in this group and no complications related to allogenic blood vessel. The incidence of postoperative complications was 18.2% (6/33), and the incidence of pancreatic fistula was 6.1% (2/33), all of which were biochemical fistula. There were 32 patients were followed up, and the follow-up rate was 96.9%. The median survival time was 14.6 months. The half-year, 1-year and 2-year survival rates were 75.6%, 37.6% and 27.4%.@*Conclusion@#The application of vascular replacement technique with allogenic blood vessel for pancreatic carcinoma has a great significance for improving the R0 resection rate and the prognosis of patients.

Effect of lung protection ventilation on postoperative lung complications in patients with esophageal cancer / 中国内镜杂志

Objective?To investigate the effect of lung protection ventilation on postoperative pulmonary complications in patients with esophageal cancer.?Methods?98 patients underwent thoracoscopic laparoscopic esophagectomy for radical resection from January 2014 to January 2017 were enrolled in this study. Patients were divided into observation group (n = 49) and control group (n = 49) randomly. Two groups of patients underwent intraoperative single lumen tracheal catheter supplemented with CO2 pneumothorax. The control group received conventional ventilation. The protective group of patients in the observation group were given protective ventilation. The time of tracheal intubation after 10 min (T1); single lung ventilation 1 h (T2); at the end of surgery (T3); 24 h (T4) after pulmonary function parameters, inflammatory response, blood gas were analyzed. The patients were divided into recurrence group (n = 24) and non-recurrence group (n = 74), pulmonary complications and its related factors were analyzed according to whether the patient had recurrent or not pulmonary complications after recurrent (n = 24) or non-recurrent (n = 74).?Results?Pplat, airway peak pressure (Ppeak), airway resistance (Raw), interleukin-6 (IL-6), and interleukin-8 (in the two groups) at time T1. Interleukin-8, (IL-8), soluble intercellular adhesion molecule-1 (Sicam-1), partial pressure of carbon dioxide in artery (PaCO2), partial pressure of oxygen There was no significant difference in the index of oxygen, PaO2, and oxygenation index (PaO2/FiO2) (P > 0.05); the changes in Pplat, Ppeak, and Raw in the control group between T1 and T3 were significantly greater than those in the observation group. The changes of IL-6, IL-8, and Sicam-1 in the control group from T1 to T4 were significantly greater than those in the observation group (P < 0.05). T1 to T4 The change of PaO2 in the control group was significantly greater than that in the observation group, and the difference was statistically significant (P < 0.05). There were multiple pulmonary complications in some patients in both groups. There were 18.36% in the observation group and 30.61% in the control group combined with various types of pulmonary complications. The difference was statistically significant (P < 0.05). Preoperative smoking, operation time, degree of radicalization, clinical pathological stage, lymphatic infiltration, microvascular infiltration, postoperative adjuvant chemotherapy, and pulmonary complications in patients undergoing radical surgery for esophageal cancer were closely related (P < 0.05).?Conclusion?Lung protection ventilation can relieve the thoracoscopic laryngeal esophageal cancer surgery in the airway resistance, pressure and inflammation, increased oxygen saturation, should strengthen the high risk of pulmonary complications in patients with monitoring, targeted prevention, reduce postoperative the incidence of pulmonary complications.