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Objective: To compare the perioperative and recent curative effects of laparoscopic radical resection of low rectal rectal carcinoma by natural orifice specimen extraction surgery (NOSES) with two-step procedure to turn rectum out from the abdominal cavity and traditional one-step procedure to turn rectum out from abdominal cavity. Methods: The clinical data of 63 patients who were treated by laparoscopic radical resection of low rectal rectal carcmoma by NOSES were analyzed retrospectively. A total of 39 patients were treated with the method of two-step procedure to turn rectum out from the abdominal cavity (two-step procedure group) and 24 patients were treated with the traditional one-step procedure to turn rectum out from the abdominal cavity (traditional one-step procedure group). Results: The maximum tumor diameters, the successful rates, tumor fragmentation rates, operation time, intraperative bleeding loss, postoperative exhaust time, anastomotic leakage rates after operation, and the shortterm-follow-up results of the patients in two groups were recovered The specimens of 39 patients in two-step procedure group were successfully pulled out from the anus, the anastomosis was finishehed after resection, and the NOSES of low rectal carcinoma was successfully completed, while 3 cases were failed of 24 cases in traditional onestep procedure group, the successful rate was decreased (P=0. 024). After the specimen were pulled out from the anus, the fragmentation rate of the patients in two-step procedure group was lower than that in traditional one-step procedure group (P=0. 004). The operation time of the patients in two-step procedure group was less than that in traditional one-step procedure group (t=4. 266, P<0. 01). There were no significant differences in the maximum diameters of tumor (t= - 0.406, P=0. 686), intraoperative bleeding loss (t=1.799, P=0. 075), postoperative exhaust time (t=- 0.144, P= 0.886), postoperative anastomotic leakage rate (P= 1.000) of the patients between two groups. During 3 to 24 months of follow-up, there were no significant differences in the recurrence rate (P = 0. 140) and metastatic rate of carcinoma (P = 0. 36) of the patients between two groups. Conclusion: Two-step procedure to turn rectum out from the abdominal cavity can reduce the pressure on the tumor during turning the rectum out, which can save the operation time and get good short-term curative effect during the radical resection of low rectal carcinoma by NOSES.
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Objective To explore the correlation of of lymph node metastasis rate ( LR) with postoperative recurrence and prognosis in patients with thyroid papillary carcinoma (PTC). Methods From January 2010 to June 2013,the clinical data of sixty-two patients with PTC in Baoshan Branch,Shanghai First People′s Hospital were retrospectively analyzed. According to the LR, patients were divided into low LR (＜25%) group(38 cases),high LR(≥25%) group (24 cases). The clinical pathological characteristics, postoperative recurrence and 5-year survival rate of the two groups was compared,and the influence factors of prognosis were analyzed. Results There was significant difference in LR among patients with different ages,numbers of lesions,lesion diameters,TNM stages and numbers of lymph node metastasis (P＜0. 05);compared with high LR group,the recurrence in low LR group was obviously reduced(15. 8% vs. 41. 7%), and 5-year survival rate was significantly increased ( 92. 1% vs. 63. 0%) ( P＜0. 05) . LR and TNM stage were the independent risk factors of prognosis in PTC patients,and age was independent protection factor (HR＝1. 587,1. 714,0. 617,P＜0. 05). Conclusion LR can be used as one of postoperative recurrence and prognosis evaluation indicators of PTC.
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Background and purpose:This study aimed to investigate the relationship between lymph node metastatic rate (LR) and response to radioiodine therapy in patients with papillary thyroid carcinoma (PTC).Methods:A total number of 143 PTC patients after radioiodine therapy were included and classified into 4 groups [Ⅰ(0%-10%),Ⅱ(>10%-25%),Ⅲ(>25%-50%),Ⅳ(>50%)] according to the lymph node metastatic rate, and the responses to initial radioiodine therapy after a median follow-up period of 20.7 months were evaluated. They were classiifed into 4 groups [excellent response (ER), indeterminate response (IDR), biochemical incomplete response (BIR), and struc-tural incomplete response (SIR)] according to the guideline proposed by 2015 American Thyroid Association. One-Way analysis of variance,χ2 test and Kruskal-Wallis test were used to evaluate the differences in basic clinicopathological features and clinical responses among the 4 groups. The ROC curve was analyzed to evaluate the clinical value of lymph node metastatic rate for predicting ER and optimal cut-off point.Results:There were no signiifcant differences in gender and T-stage among 4 groups (P>0.05). However,Ⅰ group was signiifcantly older than the other 3 groups (P=0.001). With the increase of lymph node metastatic rate, the number of ER cases decreased, while cases of BIR and SIR generally increased. Compared with the other 3 groups, less cases of ER (27.8%), while more BIR (27.8%) or SIR (11.1%) were observed in groupⅣ (H=18.816,P=0.000). Cut-off value of lymph node involved rate was 52.27%, with a better speciifcity of predicting ER. Area under the ROC curve was 0.668.Conclusion:The higher lymph node metastatic rate in patients with PTC, the worse clinical outcome it could be. A cut-off value of lymph node metastatic rate 52.27% is a speciifc independent predictor for the clinical outcome in PTC patients treated with radioiodine therapy.