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Objective:To investigate the efficacy of different conversion therapies for colorectal cancer with unresectable simultaneous liver metastasis.Methods:A total of 170 patients of colorectal cancer complicated with liver metastasis who were admitted to the First Affiliated Hospital of Nanchang University from Jan 2015 to Dec 2020 were included in the study. Patients were divided into an initial resectable group (42 cases) and an initial non-resectable group (128 cases).Results:There were no significant differences in OS and PFS between patients with CRLM (colorectal cancer with liver metastasis) who were resected initially and those successfully underwent transformation therapy ( P>0.05). The median OS was 36 months in the group with successful transformation, while it was 21 months in the group with simple primary tumor resection and no liver metastasis resection ( P=0.014), HR=0.48 (0.27-0.86). The median PFS was 28 months in the successful conversion group, while it was 10 months in the primary tumor resection only and no liver metastasis resection ( P=0.005), HR=0.43 (0.24-0.77). The OS difference between the group with simple primary tumor resection and no resected liver metastasis and the group with neither primary tumor nor liver metastasis resection was statistically significant: (21 months vs.13 months), HR=0.52 (0.32-0.86) ( P=0.01), while the PFS between the two groups was not statistically significant, ( P>0.05). Conclusions:Chemotherapy combined with targeted therapy has the best effect among the conversion therapies, and can improve the resection rate and survival rate of patients undergoing R 0 surgery. Resection of the primary lesion alone can also prolong the patient's survival.
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Robotic surgical system natural orifice specimen extraction surgery in rectal cancer has been carried out for nearly 10 years, which has entered the mature stage of technology. Development of the surgery in a healthy, orderly, scientific and standardized manner needs systema-tic, strict and whole-process quality control. Based on relevant literatures at home and abroad, and combined with team practical experiences, the authors elaborate on the key points of quality control of robotic surgical system natural orifice specimen extraction surgery in radical resection of rectal cancer, from the aspects of preoperative, intraoperative and postoperative quality control, as well as the quality control of surgeon training and qualifications, in order to provide reference for safe implementation and promotion of the surgery.
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Inflammatory myofibroblastic tumor (IMT) of gastrointestinal tract is a rare and low malignant mesenchymal tumor, which is composed of differentiated myofibroblastoid spindle cells and often accompanied by numerous inflammatory cells such as plasma cells, lymphocytes, and eosinophils. Surgical resection is the preferred treatment for IMT of gastrointestinal tract, and patients can achieve a good prognosis after surgery. In recent years, with the progress of imaging examination and pathological diagnosis technology, the detection rate of IMT of gastrointes-tinal tract has been greatly improved, but its pathogenesis and mechanism have not been completely investigated, requiring further research results to confirm. At the same time, due to the lack of standardized strategies for diagnosis and treatment of IMT of gastrointestinal tract, it was inevitable to miss diagnosis or treatment in clinical diagnosis and treatment. By reviewing relevant literatures and combined with the team's practical experience, the authors summarize the research progress of the diagnosis and treatment of IMT of gastrointestinal tract from the aspects of pathogenesis, clinical diagnosis and treatment strategies of IMT, aiming to provide references for the clinical treatment of surgeons.
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Objective:To investigate the 10-year outcome and prognostic factors of laparo-scopic D 2 radical distal gastrectomy for locally advanced gastric cancer. Methods:The retrospec-tive cohort study was conducted. The clinicopathological data of 652 patients with locally advanced gastric cancer who were admitted to 16 hospitals from the multicenter database of laparoscopic gastric cancer surgery in the Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group, including 214 cases in the First Affiliated Hospital of Army Medical University, 191 cases in Fujian Medical University Union Hospital, 52 cases in Nanfang Hospital of Southern Medical University, 49 cases in West China Hospital of Sichuan University, 43 cases in Xijing Hospital of Air Force Medical University, 25 cases in Jiangsu Province Hospital of Chinese Medicine, 14 cases in the First Medical Center of the Chinese PLA General Hospital, 12 cases in No.989 Hospital of PLA, 12 cases in the Third Affiliated Hospital of Sun Yat-Sen University, 10 cases in the First Affiliated Hospital of Nanchang University, 9 cases in the First People's Hospital of Foshan, 7 cases in Zhujiang Hospital of Southern Medical University, 7 cases in Fujian Medical University Cancer Hospital, 3 cases in Zhongshan Hospital of Fudan University, 2 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 2 cases in Peking University Cancer Hospital & Institute, from February 2004 to December 2010 were collected. There were 442 males and 210 females, aged (57±12)years. All patients underwent laparoscopic D 2 radical distal gastrectomy. Observation indicators: (1) surgical situations; (2) postoperative pathological examination; (3) postoperative recovery and complications; (4) follow-up; (5) prognostic factors analysis. Follow-up was conducted by outpatient examination and telephone interview to detect the tumor recurrence and metastasis, postoperative survival of patients up to March 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers or percen-tages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was analyzed using the rank sum test. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-Rank test was used for survival analysis. Univariate and multivariate analyses were analyzed using the COX hazard regression model. Results:(1) Surgical situations: among 652 patients, 617 cases underwent D 2 lymph node dissection and 35 cases underwent D 2+ lymph node dissection. There were 348 cases with Billroth Ⅱ anastomosis, 218 cases with Billroth Ⅰ anastomosis, 25 cases with Roux-en-Y anastomosis and 61 cases with other digestive tract reconstruction methods. Twelve patients had combined visceral resection. There were 569 patients with intraoperative blood transfusion and 83 cases without blood transfusion. The operation time of 652 patients was 187(155,240)minutes and volume of intraoperative blood loss was 100(50,150)mL. (2) Postoperative pathological examina-tion: the maximum diameter of tumor was (4.5±2.0)cm of 652 patients. The number of lymph node dissected of 652 patients was 26(19,35), in which the number of lymph node dissected was >15 of 570 cases and ≤15 of 82 cases. The number of metastatic lymph node was 4(1,9). The proximal tumor margin was (4.8±1.6)cm and the distal tumor margin was (4.5±1.5)cm. Among 652 patients, 255 cases were classified as Borrmann type Ⅰ-Ⅱ, 334 cases were classified as Borrmann type Ⅲ-Ⅳ, and 63 cases had missing Borrmann classification data. The degree of tumor differentiation was high or medium in 171 cases, low or undifferentiated in 430 cases, and the tumor differentiation data was missing in 51 cases. There were 123, 253 and 276 cases in pathological stage T2, T3 and T4a, respectively. There were 116, 131, 214 and 191 cases in pathological stage N0, N1, N2 and N3, respectively. There were 260 and 392 cases in pathological TNM stage Ⅱ and Ⅲ, respectively. (3) Postoperative recovery and complications: the time to postoperative first out-of-bed activities, time to postoperative first flatus, time to the initial liquid food intake, duration of postoperative hospital stay of 652 patients were 3(2,4)days, 4(3,5)days, 5(4,6)days, 10(9,13)days, respectively. Among 652 patients, 69 cases had postoperative complications. Clavien-Dindo grade Ⅰ-Ⅱ, grade Ⅲa, grade Ⅲb, and grade Ⅳa complications occurred in 60, 3, 5 and 1 cases, respectively (some patients could have multiple complications). The duodenal stump leakage was the most common surgical complication, with the incidence of 3.07%(20/652). Respiratory complication was the most common systemic complication, with the incidence of 2.91%(19/652). All the 69 patients were recovered and discharged successfully after treatment. (4) Follow-up: 652 patients were followed up for 110-193 months, with a median follow-up time of 124 months. There were 298 cases with postoperative recurrence and metastasis. Of the 255 patients with the time to postoperative recurrence and metastasis ≤5 years, there were 21 cases with distant metastasis, 69 cases with peritoneal metastasis, 37 cases with local recurrence, 52 cases with multiple recurrence and metastasis, 76 cases with recurrence and metastasis at other locations. The above indicators were 5, 9, 10, 4, 15 of the 43 patients with the time to postoperative recurrence and metastasis >5 years. There was no significant difference in the type of recurrence and metastasis between them ( χ2=5.52, P>0.05). Cases in pathological TNM stage Ⅱ and Ⅲ were 62 and 193 of the patients with the time to postoperative recurrence and metastasis ≤5 years, versus 23 and 20 of the patients with the time to postoperative recurrence and metastasis >5 years, showing a significant difference in pathological TNM staging between them ( χ2=15.36, P<0.05). Cases in pathological stage T2, T3, T4a were 42, 95, 118 of the patients with the time to postoperative recurrence and metastasis ≤5 years, versus 9, 21, 13 of the patients with the time to postoperative recurrence and metastasis >5 years, showing no significant difference in pathological T staging between them ( Z=-1.80, P>0.05). Further analysis showed no significant difference in cases in pathological stage T2 or T3 ( χ2=0.52, 2.08, P>0.05) but a significant difference in cases in pathological stage T4a between them ( χ2=3.84, P<0.05). Cases in pathological stage N0, N1, N2, N3 were 19, 44, 85, 107 of the patients with the time to postoperative recurrence and metastasis ≤5 years, versus 12, 5, 18, 8 of the patients with the time to postoperative recurrence and metastasis >5 years, showing a significant difference in pathological N staging between them ( Z=-3.34, P<0.05). Further analysis showed significant differences in cases in pathological stage N0 and N3 ( χ2=16.52, 8.47, P<0.05) but no significant difference in cases in pathological stage N1 or N2 ( χ2=0.85, 1.18, P>0.05). The median overall survival time was 81 months after surgery and 10-year overall survival rate was 46.1% of 652 patients. The 10-year overall survival rates of patients in TNM stage Ⅱ and Ⅲ were 59.6% and 37.5%, respectively, showing a significant difference between them ( χ2=35.29, P<0.05). In further analysis, the 10-year overall survival rates of patients in pathological TNM stage ⅡA, ⅡB, ⅢA, ⅢB and ⅢC were 65.6%, 55.8%, 46.9%, 37.1% and 24.0%, respectively, showing a significant difference between them ( χ2=55.06, P<0.05). The 10-year overall survival rates of patients in patholo-gical stage T2, T3 and T4a were 55.2%, 46.5% and 41.5%, respectively, showing a significant difference between them ( χ2=8.39, P<0.05). The 10-year overall survival rates of patients in patholo-gical stage N0, N1, N2 and N3 were 63.7%, 56.2%, 48.5% and 26.4%, respectively, showing a signifi-cant difference between them ( χ2=54.89, P<0.05). (5) Prognostic factors analysis: results of univariate analysis showed that age, maximum diameter of tumor, degree of tumor differentiation as low or undifferentiated, pathological TNM staging, pathological T staging, pathological stage N2 or N3, post-operative chemotherapy were related factors for the 10-year overall survival rate of locally advanced gastric cancer patients undergoing laparoscopic D 2 radical distal gastrectomy ( hazard ratio=1.45, 1.64, 1.37, 2.05, 1.30, 1.68, 3.08, 0.56, 95% confidence interval as 1.15-1.84, 1.32-2.03, 1.05-1.77, 1.62-2.59, 1.05-1.61, 1.17-2.42, 2.15-4.41, 0.44-0.70, P<0.05). Results of multivariate analysis showed that maximum diameter of tumor >4 cm, low-differentiated or undifferentiated tumor, pathological TNM stage Ⅲ were independent risk factors for the 10-year overall survival rate of locally advanced gastric cancer patients undergoing laparoscopic D 2 radical distal gastrectomy ( hazard ratio=1.48,1.44, 1.81, 95% confidence interval as 1.19-1.84, 1.11-1.88, 1.42-2.30, P<0.05) and postoperative chemotherapy was a independent protective factor for the 10-year overall survi-val rate of locally advanced gastric cancer patients undergoing laparoscopic D 2 radical distal gastrec-tomy ( hazard ratio=0.57, 95% confidence interval as 045-0.73, P<0.05). Conclusions:Laparoscopic assisted D 2 radical distal gastrectomy for locally advanced gastric cancer has satisfactory 10-year oncologic outcomes. A high proportion of patients in pathological TNM stage Ⅲ, pathological stage T4a, pathological stage N3 have the time to postoperative recurrence and metastasis ≤5 years, whereas a high proportion of patients in pathological TNM stage Ⅱ or pathological stage N0 have the time to postoperative recurrence and metastasis >5 years. Maximum diameter of tumor >4 cm, low-differentiated or undifferentiated tumor, pathological TNM stage Ⅲ are independent risk factors for the 10-year overall survival rate of locally advanced gastric cancer patients undergoing laparos-copic D 2 radical distal gastrectomy. Postoperative chemotherapy is a independent protective factor for the 10-year overall survival rate of locally advanced gastric cancer patients undergoing laparos-copic D 2 radical distal gastrectomy.
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Objective:To investigate the influencing factors for the number of lymph node harvested after Da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 1 396 patients who underwent Da Vinci robotic or laparoscopic radical gastrectomy for gastric cancer in the First Affiliated Hospital of Nanchang University from December 2014 to July 2019 were collected. There were 991 males and 405 females, aged (60±11) years. Surgery using Da Vinci robotic system or laparoscopic system was completed according to patients' wishes. Cases with early gastric cancer underwent D 1+ lymphadenectomy and cases with advanced gastric cancer underwent standard D 2 lymphadenectomy. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) influencing factors for the number of lymph node harvested after radical gastrectomy for gastric cancer; (4) follow-up and survival. Follow-up using outpatient examination or telephone interview was performed to detect survival of patients up to October 2020. Measurement data with normal distribution were represented as Mean± SD. Univariate analysis was done using the chi-square test or Fisher exact probability. Multivariate analysis was performed using Logistic regression model. The survival rate was calculated by Kaplan-Meier method. Results:(1) Intraoperative situations: all the 1 396 patients underwent radical gastrectomy, including 415 cases undergoing Da Vinci robotic radical gastrectomy and 981 cases undergoing laparoscopic radical gastrectomy. Thirty-five of the 1 396 patients were converted to open surgery, including 5 cases undergoing Da Vinci robotic radical gastrectomy and 30 cases undergoing laparoscopic radical gastrectomy. Of the 1 396 patients, 983 cases underwent distal gastrectomy, 400 cases underwent total gastrectomy and 13 cases underwent proximal gastrectomy, among which 597 cases underwent Billroth Ⅰ anastomosis, 385 cases underwent Billroth Ⅱ anastomosis, 401 cases underwent Roux-en-Y anastomosis and 13 cases underwent residual stomach-esophagus anastomosis. The operation time, volume of intraoperative blood loss and cases with intraoperative blood transfusion were (221±51)minutes, (201±81)mL, 24 of 415 cases undergoing Da Vinci robotic radical gastrectomy, and (196±42)minutes, (232±76)mL, 75 of 981 cases undergoing laparoscopic radical gastrectomy, respectively. (2) Postoperative situations: the time to postoperative first flatus, time to postoperative initial liquid food intake and duration of postoperative hospital stay of the 1 396 patients were (3.0±1.0) days, (4.2±1.5) days and (9.0±3.8) days, respectively. Two hundred and ten of the 1 396 patients had postoperative complications including 170 cases with grade Ⅰ-Ⅱ complications and 40 cases with grade Ⅲ-Ⅴ complications. Eight of the 210 patients with postoperative complications died of serious complica-tions and the other 202 cases were cured after symptomatic treatment. Results of postoperative histopathological examination showed that there were 958 cases of adenocarcinoma, 220 cases of mucinous adenocarcinoma, and 218 cases of signet ring cell carcinoma. The number of lymph node harvested and the number of positive lymph node of the 1 396 patients were 26.0±8.3 and 3.6±0.9, respectively, and cases with the number of lymph node harvested ≥16 or <16 were 1 312 and 84. (3) Influencing factors for the number of lymph node harvested after radical gastrectomy for gastric cancer: results of univariate analysis showed that the operating surgeon, operation method, range of gastric resection, nerve invasion, degree of tumor invasion and tumor pathological N stage were related factors influencing the number of lymph node harvested after Da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer ( χ2=13.167, 6.029, 15.686, 5.573, 9.402, 17.139, P<0.05). Results of multivariate analysis showed that the operating surgeon, operation method, range of gastric resection and tumor pathological N stage were independent factors influencing the number of lymph node harvested after Da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer ( odds ratio=1.589, 2.018, 1.787, 0.267, 95% confidence interval as 1.221?2.068, 1.140?3.570, 1.066?2.994, 0.103?0.689, P<0.05). (4) Follow-up and survival: of the 1 396 patients, 1 256 cases were followed up for 2 to 70 months, with a median follow-up time of 27 months. The 3-year cumulative survival rate of the 1 256 cases was 70.2%. Conclusion:The operating surgeon, operation method, range of gastric resection and tumor pathological N stage are independent factors influencing the number of lymph node harvested after Da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer.
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Objective:To investigate the application value of enhanced recovery after surgery (ERAS) in totally Da Vinci robotic total gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 97 patients with gastric cancer who underwent totally Da Vinci robotic total gastrectomy in the First Affiliated Hospital of Nanchang University between January 2016 and February 2019 were collected.There were 57 males and 40 females, aged (59±10)years, with a range from 35 to 60 years. Of the 97 patients, 52 receiving perioperative management using ERAS were allocated into ERAS group, and 45 receiving traditional perioperative management were allocated into traditional group. Observation indicators: (1) intraoperative situations; (2) postoperative situations. Measurement data with normal distribution were expressed as Mean± SD, and comparison between groups was analyzed using the t test. Count data were described as absolute numbers, and the chi-square test was used for comparison between groups. Repeated measurement data were analyzed by ANOVA. Comparison of ordinal datas was analyzed using the Mann-Whitney U test. Results:(1) Intraoperative situations: patients in the ERAS group and traditional group underwent totally Da Vinci robotic total gastrectomy for gastric cancer successfully. Cases with Roux-en-Y anastomosis or uncut Roux-en-Y anastomosis (methods of digestive reconstruction), operation time, volume of intraoperative blood loss for the ERAS group were 25, 27, (205±28)minutes, (176±80)mL, respectively, versus 21, 24, (199±31)minutes, (182±81)mL for the traditional group, showing no significant difference in the above indicators between the two groups ( χ2=0.02, t=1.00, 0.37, P>0.05). (2) Postoperative situations: time to first out-of-bed activities, time to first anal flatus, time to initial liquid food intake, time to abdominal drainage tube removal, cases with postoperative complications, the number of lymph node dissected, cases in stage Ⅰ, Ⅱ, Ⅲ of postoperative tumor staging, duration of postoperative hospital stay, hospitalization expenses were (1.85±0.29)days, (2.90±0.47)days, (2.53±0.28)days, (5.72±0.95)days, 6, 28±8, 4, 25, 23, (6.43±0.52)days, (60 222±3 888)yuan in the ERAS group and (3.04±0.39)days, (3.82±0.36)days, (4.24±0.30)days, (6.75±0.48)days, 5, (27±6)days, 3, 20, 22, (8.47±0.69)days, (64 197±3 369)yuan in the traditional group, respectively. There were significant differences in the time to first out-of-bed activities, time to first anal flatus, time to initial liquid food intake, time to abdominal drainage tube removal, duration of postoperative hospital stay and hospitalization expenses between the two groups ( t=17.19, 10.69, 29.02, 6.58, 16.57, 5.34, P<0.05). There was no significant difference in the postoperative complications, the number of lymph node dissected, or postoperative tumor staging between the two groups ( χ2=0.01, t=0.68, Z=-0.46, P>0.05). From 2 hours after anesthesia awakening to 48 hours after surgery, the visual analog pain scores were changed from 3.06±0.29 to 2.13±0.32 in the ERAS group, and from 4.11±0.74 to 3.26±0.42 in the traditional group, respectively, showing a significant difference in the changing trend between the two groups ( F=264.45, P<0.05). There was no death or readmission in the postoperative 30 days. Conclusions:ERAS applied in the totally Da Vinci robotic total gastrectomy is safe and effective, which is associated with faster gastrointestinal function recovery, shorter hospital stay, better pain control, and quicker recovery afer surgery.
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Objective To investigate the clinical efficacy of Da Vinci robotic and laparoscopic distal gastrectomy for gastric cancer.Methods The propensity score matching and retrospective cohort study was conducted.The clinicopathological data of 171 patients with gastric cancer who were admitted to the First Affiliated Hospital of Nanchang University from January 2015 to October 2016 were collected.There were 110 males and 61 females,aged from 38 to 81 years,with a median age of 57 years.Of 171 patients,70 undergoing Da Vinci robotic distal gastrectomy for gastric cancer and 101 undergoing laparoscopic distal gastrectomy were allocated into the robotic group and laparoscopic group,respectively.Observation indicators:(1) the propensity score matching conditions and comparison of general data between the two groups after the propensity score matching;(2) intraoperative and postoperative situations;(3) situations of pathological examination;(4) follow-up.Patients were followed up by outpatient examination and telephone interview to detect severe complications and survival after discharge up to October 2018.The overall survival time was from the operation data to end of follow-up or time of death.The propensity score matching was used to perform 1 ∶ 1 matching by Empower Stats.Measurement data with normal distribution were represented as Mean ± SD,and comparison between groups was done using the t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was done using the Mann-Whitney U test.Count data were represented as absolute number,and comparison between groups was analyzed using the chi-square test and comparison of ordinal data between groups was analyzed using the Mann-Whitney U test.The survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method,and Log-rank test was used for survival analysis.Results (1) The propensity score matching conditions and comparison of general data between the two groups after the propensity score matching:124 of 171 patients had successful matching,including 62 in each group.The body mass index (BMI) and tumor diameter before matching were (24.2±2.4)kg/m2 and (50±13)mm in the robotic group,(25.1±2.1) kg/m2 and (45±14) mm in the laparoscopic group,showing statistically significant differences between the two groups (t =-2.676,2.045,P＜ 0.05).The BMI and tumor diameter after matching were (24.5 ± 2.3) kg/m2 and (49 ± 14) mm in the robotic group,(24.4 ± 2.2) kg/m2 and (48 ± 12) mm in the laparoscopic group,showing no statistically significant difference between the two groups (t=0.110,0.524,P＞0.05).(2) Intraoperative and postoperative situations:the total operation time,volume of intraoperative blood loss,level of C-reactive protein at day 1 postoperatively,level of C-reactive protein at day 3 postoperatively,volume of totally abdominal drainage were (147±13) minutes,(115±12)mL,(52.2±7.2)mg/L,(33.7±11.9)mg/L,353.5 mL (range,267.0-1 350.0 mL) in the robotic group,and (140± 12) minutes,(131 ± 12) mL,(58.2±7.4) mg/L,(41.1 ± 16.9) rag/L,397.0 mL (range,255.0-1 600.0 mL) in the laparoscopic group,respectively,showing statistically significant differences in the above indexes between the two groups (t =3.163,-7.814,-4.631,-2.840,Z =-4.351,P＜0.05).(3) Situations of pathological examination:patients after matching in the two groups received R0 resection,with negative duodenal margin and gastric margin.The number of lymph nodes dissected in the robotic group and laparoscopic group were 22±4 and 20±4,respectively,with a statistically significant difference between the two groups (t=2.812,P＜0.05).(4) Follow-up:124 patients after propensity score matching were followed up for 6-37 months,with a median time of 25 months.During the follow-up,no severe surgery-related complications such as obstruction of input or output loop and dumping syndrome were found in the two groups within 3 months after operation.The 2-year overall survival rate was 82.1％ and 75.2％ in the robotic and laparoscopic group,with no statistically significant difference between the two groups (x2 =0.436,P＞0.05).Conclusions Compared with laparoscopic surgery,Da Vinci robotic distal gastrectomy for gastric cancer has advantages in postoperative recovery and minimally invasion.There are similar 2-year overall survival rates in the two groups.
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Objective@#To explore the short-term clinical efficacy of robotic radical resection for high rectal cancer with transvaginal specimen extraction.@*Methods@#A cohort study was carried out. The clinical data of consecutive patients with high rectal cancer who underwent robotic radical resection at the Department of General Surgery of The First Affiliated Hospital of Nanchang University from June 2017 to January 2018 were retrospectively analyzed. Inclusion criteria: (1) preoperative diagnosis of rectal cancer, and distance from tumor to anal margin≥10 cm undercolonoscopy; (2) T1-3 assessed by preoperative imaging examination, and no distant metastasis; (3) female, age≥50 years old, body mass index ≤ 30 kg/m2; (4) without radiotherapy and chemotherapy before surgery; (5) implementation of robotic radical surgery for high rectal cancer. Fourteen female patients undergoing transvaginal removal of specimen without abdominal incision were included in the no incision group with age of (62.2±9.3) years old and distance from tumor to anal verge of (12.5±0.9) cm. As the match of 1:2, 28 simultaneous patients of high rectal cancer undergoing traditional robotic surgery (surgery interval <8 months) were enrolled to the control group, with age of (60.6±12.8) years old and distance from tumor to anal verge of (11.3±3.8) cm. Short-term efficacy and safty were compared between two groups. Follow-up ended in September 2018.@*Results@#There was no significant difference in baseline data between the two groups (all P>0.05). Compared with the control group, the no incision group had longer operation time [(149.6±15.6) minutes vs. (130.9±12.9) minutes, t=-4.135, P<0.001], shorter time to postoperative flatus [(40.9 ±2.6) hours vs. (51.9±2.9) hours, t=12.049, P<0.001], lower pain score on the operation day and the first day after surgery (using Changhaipainstick) [(3.1±0.4) points vs. (4.6±0.7) points, t=7.458, P<0.001; (2.5±0.3) points vs. (3.3±0.5) points, t=6.142, P<0.001], shorter time to ground activity [(15.6±2.0) hours vs. (24.3±2.5) hours, t=11.102, P=0.030], and shorter postoperative hospital stay [(6.1±0.8) days vs. (7.2±1.3) days, t=2.806, P=0.008], whose differences were statistically significant. There were no significant differences in intraoperative blood loss, proportion of postoperative analgesia patients, and complication within 30 days after surgery (all P>0.05). In the no incision group and the control group,the tumor size was (3.1±0.4) cm and (3.6±0.9) cm, the proximal margin distance was (9.1±1.5) cm and (9.8±1.5) cm, the distal margin distance was (4.3±0.4) cm and (4.5±0.4) cm, the number of harvested lymph node was 15.8±2.4 and 15.2 ± 2.5, and the number of positive lymph node was 0.6±1.3 and 1.1±2.4, respectively, whose differences were not statistically significant (all P>0.05). The mean followed-up period was 10 months (7-14 months) in the no incision group, and 14 months (10-18 months) in the control group. No local recurrence and distant metastasis were found in both groups.@*Conclusion@#Robotic radical resection for high rectal cancer with transvaginal specimen extraction is safe and feasible with advantages of rapid postoperative recovery, less postoperative pain and short hospital stay.
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Objective@#To compare the short-term and long-term outcomes of robotic rectectomy and laparoscopic rectectomy for rectal cancer based on propensity score matching.@*Methods@#The clinical data of 106 patients who underwent robotic or laparoscopic radical resection of rectal cancer at Department of General Surgery, the First Affiliated Hospital of Nanchang University from January 2015 to December 2015 were retrospectively collected. Propensity score matching method was used to perform 1∶1 matching between robot and laparoscopic rectal cancer radical surgery. Thirty-two patients in robot group and 32 patients in laparoscopic group were successfully matched. There were 15 males and 17 females in the robotic group, aging (56.2±7.5) years, 19 males and 13 females in the laparoscopic group, aged (55.5±7.6) years. The clinical outcome of the two groups were compared using t-test or Mann-Whitney U test for continuous variables, repeated measures analysis of variance, χ2 test, Fisher exact test or Wilcoxon rank sum test for dichotomous variables. The overall survival curve was drawn by Kaplan-Meier curve and the difference of survival curve was compared by Log-rank method.@*Results@#The general data of the two groups of patients were comparable after matching. Sixty-four patients successfully completed robotic or laparoscopic operation without conversion to open surgery or perioperative death case. The total operative time, the lymph node namely No. 253 group dissection time, intraoperative blood loss, postoperative urethral catheter retention time, the serum C-reactive protein levels of 24 hours after surgery were (135.7±12.1) minutes, (11.6±2.7) minutes, (66.8±10.2) ml, 3.0(1.0) d,(50.9±7.7) μg/L, respectively, while in laparoscopic group were (124.9±23.2) minutes, (13.2±2.7) minutes, (74.8±13.9) ml, 4.0(2.0) d, (55.9±6.7) μg/L respectively. The differences were statistically significant (t=2.341, t=-2.354, t=-2.621, Z=-2.743, F=7.902, respectively, P<0.05). There were no statistical differences in separation time, numbers of retrieved lymph nodes, time to first flatus, postoperative hospital stay, postoperative complication and Clavien-Dindo classification of postoperative complications (t=0.336, t=0.714, t=-0.568, Z=-1.766, Fisher Z=-0.586, respectively, all P>0.05).@*Conclusions@#Robotic surgery not only has similar safety and feasibility but also has advantages of short-term outcomes compared with laparoscopic rectectomy for rectal cancer. The long-term outcomes were similar between two groups.
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Animal infectious diseases pose a serious and continuing threat to the animal health and cause huge economic losses throughout the world. Vaccination is one of the most effective solutions to prevent and control animal infectious diseases. With the development of biotechnologies and the need for disease prevention and control, the focus of vaccine research has been shifted to the development of safe, efficient, broad-spectrum, low-dose and marker vaccines. Novel vaccines capable of inducing high levels of both humoral and cellular immune responses are promising to provide more efficient protection against animal infectious diseases. This minireview summarizes the development, applications, advantages and disadvantages of new-concept animal vaccines emerging in recent years, including mucosal vaccines, long-acting and fast-acting vaccines, chimeric vaccines, nanoparticle vaccines, and so on. Furthermore, we discuss future directions of the vaccines, in order to provide new insights for animal vaccine development.
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Animales , Enfermedades Transmisibles , Inmunidad Celular , Nanopartículas , Vacunación , VacunasRESUMEN
Objective To systematically evaluate the short-term outcomes of Da Vinci robotic surgical system and laparoscopy in pancreaticoduodenectomy.Methods Literatures were researched using PubMed,Embase,Medline,VIP database,Chinese Journal Fulltext Database from January,2013 to October,2016 with the key words including laparoscopic,robotic,Da Vinci,pancreaticoduodenectomy,腹腔锐,达芬奇机器人,胰十二指肠切除术”.The cohort studies about comparison of short-term outcomes of Da Vinci robotic surgical system and laparoscopy in pancreaticoduodenectomy were received and enrolled.Patients undergoing pancreaticoduodenectomy using Da Vinci robotic surgical system and laparoscopy were respectively allocated into the Da Vinci group and laparoscopy group.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as odd ratio (OR) and 95％ confidence interval (CI).Measurement data were represented as weighted mean difference (WMD) and 95％CI.The heterogeneity of the studies was analyzed using the I2 test.Results Five retrospective cohort studies were enrolled in the Meta analysis,and the total sample size was 364 patients,including 159 in the Da Vinci group and 205 in the laparoscopy group.The results of Meta analysis showed that there were statistically significant differences in the rate,of conversion to open surgery,spleen-preserving rate,operation time and duration of postoperative hospital stay between Da Vinci group and laparoscopy group (OR=0.18,3.80,WMD =-37.54,-4.47,95％CI:0.05-0.60,2.01-7.18,-47.46--27.62,-6.70--2.24,P＜0.05).There were no statistically significant difference in the incidence of pancreatic fistula and overall incidence of complications between Da Vinci group and laparoscopy group (OR=0.95,0.55,95％CI:0.59-1.54,0.29-1.03,P＞0.05).Conclusions Da Vinci robotic surgical system and laparoscopy are safe and feasible in pancreaticoduodenectomy,with the same incidence of postoperative complications.Compared with laparoscopy,Da Vinci robotic surgical system can not only reduce the rate of conversion to open surgery,operation time and duration of postoperative hospital stay,but also increase spleen-preserving rate,meanwhile,it does not increase the incidence of postoperative complications.
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Minimally invasive has surgery become the target of the surgeons,Da Vinci robot assisted surgical system has been used generally for colorectal cancer,with the advantages of three-dimensional high-definition imaging,flexible and high degree of freedom robotic arms,functions of action correction and shake filtration compared with laparoscopic surgery.However,advantages and disadvantages between Da Vinci robot assisted surgical system and traditional laparoscopic surgery are still controversial.In this paper,the present situation and prospect of Da Vinci robot assisted surgical system for colorectal cancer surgery are explored.
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Arboviruses represent a serious problem to public health and agriculture worldwide.Fast,accurate identification of the viral agents of arbovirus-associated disease is essential for epidemiological surveillance and laboratory investigation.We developed a cost-effective,rapid,and highly sensitive one-step triplex RT-PCR enzyme hybridizationassay for simultaneous detections of Japanese Encephallitis virus (JEV,Flaviviridae)Getah virus (GETV,Togaviridae),and Tahyna virus (TAHV,Bunyaviridae) using three pairs of primers to amplify three target sequences in one RT-PCR reaction.The analytical sensitivity of this assay was 1 PFU/mL for JEV,10PFU/mL for GETV,and 10 PFU/mL for TAHV.This assay is significantly more rapid and less expensive than the traditional serological detection and single RT-PCR reaction methods.When “triplex RT-PCR enzyme hybridization” was applied to 29 cerebrospinal fluid(CSF)samples that were JEV-positive by normal RT-PCR assay,all samples were strongly positive for JEV,but negative for GETV and TAHV,demonstrating a good sensitivity,specificity,and performance at CSF specimen detection.
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Objective:To predict Th/B cell epitopes in HA of influenza virus(H1N1)and analyze antigenicity of the candidate epitopes in order to develop epitope-bacterin by the way of bioinformatics.Methods:The HA amino acid sequences of infiuenza virus(H1N1),which the viral infection was prevalent recently,were downloaded from Genbank.The Th/B cell epitopes were predicted and analyzed by bioinformatics methods.Then,specificity and conservation of the candidate epitopes were estimated.Finally,antigenicity of the candidate epitopes was identified by influenza virus(H1N1)positiVe serum samples of mice.Results:Three Th/B cell epitopes containing HA_(73-87),HA_(125-139),HA_(188-205) were acquired Two of the candidate epitopes were in a relatively conserved domain of HA1,and a deal of 2006-2009 influenza virus(H1N1)isolates contained the sequences.Moreover,the candidate epitopes were showedin a distinct antibody combining reactivity with the influenza virus (H1N1)positive serum of mice,which inferred the predicted epitopes to be functional ones.Conclusion:The selected epitopes are able to be functional HA Th/B cell epitopes of influenza virus(H1N1).Our study also establish the foundations for the further research of influenza virus infectlon and immunity mechanism,the recognition of influenza virus(H1N1)functional epitope and the development of epitope vaccines.
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OBJECTIVE:To study the effective portion of the ultrafiltration membrane-separated ethanol extract of Pae-onia lactiflora and its antineoplastic activity in vitro. METHODS:The content of peoniflorin in ethanol extract of P.lactiflora was determined by HPLC. The drug-containing serum of mice was used to cultivate tumor cells such as HT29,HL60 and S180,then the inhibitory effect of P.lactiflora ultrafiltrate on the tumor cells and the association between dosage and administration time of the P.lactiflora ultrafiltrate were observed. RESULTS:P.lactiflora(10～100 g?kg-1) showed marked inhibition on all kinds of the above-mentioned tumor cells in a dose-dependent manner; the drug-containing serum also showed marked inhibition on all of kinds of tumor cells at different time in a time-dependent manner. CONCLUSION:The effective portion of ultrafiltration membrane-separated ethanol extract of P.lactiflora has antineoplastic activity in vitro.
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Objective To discuss a convenient and pragmatic method of fitting and optimizing standard curve for determining concentration of serum hepatitis B virus large surface protein(HBV-LP).MethodsEnzyme-linked immunosorbent assay(ELISA)was used to measure the absorbance of standard preparation of HBV-LP.Concentration and absorbance of standard preparation of HBV-LP was carried out curve fitting with 4-parameter formula model and linear model and log-linear model and quadratic polynomial model and cubic polynomial model and S model by program solution of Excel,respectively.The most standard curve for determining concentration of serum HBV-LP was determined with coefficient of determination of regression model.ResultsThe scatterplot of standard preparation of HBV-LP submited nonlinear tendency.There were all significance to regression equation of 4-parameter formula model and linear model and log-linear model and quadratic polynomial model and cubic polynomial model and S model(P
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Objective:To predict Th/B cell epitopes in HA of influenza virus(H1N1) and analyze antigenicity of the candidate epitopes in order to develop epitope-bacterin by the way of bioinformatics.Methods:The HA amino acid sequences of influenza virus (H1N1),which the viral infection was prevalent recently,were downloaded from Genbank.The Th/B cell epitopes were predicted and analyzed by bioinformatics methods.Then,specificity and conservation of the candidate epitopes were estimated.Finally,antigenicity of the candidate epitopes was identified by influenza virus (H1N1) positive serum samples of mice.Results:Three Th/B cell epitopes containing HA73-87,HA125-139,HA188-205 were acquired.Two of the candidate epitopes were in a relatively conserved domain of HA1,and a deal of 2006-2009 influenza virus (H1N1) isolates contained the sequences.Moreover,the candidate epitopes were showedin a distinct antibody combining reactivity with the influenza virus (H1N1) positive serum of mice,which inferred the predicted epitopes to be functional ones.Conclusion:The selected epitopes are able to be functional HA Th/B cell epitopes of influenza virus (H1N1).Our study also establish the foundations for the further research of influenza virus infection and immunity mechanism,the recognition of influenza virus (H1N1) functional epitope and the development of epitope vaccines.