Comparison of two types of digestive tract reconstruction after total gastrectomy in patients with gastric carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the influence of two different types of digestive tract reconstruction on the life quality, nutritional status and tolerance to adjuvant chemotherapy after total gastrectomy in patients with gastric carcinoma.</p><p><b>METHODS</b>The clinical data of a total of 107 patients treated in our department from January 2005 to december 2008 were analyzed retrospectively. Among them, 49 patients underwent digestive tract reconstruction with functional jejunal interposition (FJI group) and 58 patients underwent Roux en-Y jejunal P-type anastomosis (PR group) after total gastrectomy. 79 of 107 (73.8%) patients received postoperative adjuvant chemotherapy with XELOX regimen. The digestive complications and tolerance to chemotherapy were assessed respectively.</p><p><b>RESULTS</b>Neither severe complications nor surgery-related or chemotherapy-related death were observed among the 107 patients. There were statistical differences in the incidence rate of emaciation, dumping syndrome and retention syndrome between the FJI and PR groups (P < 0.05), but no significant statistical difference in incidence rate of reflux esophagitis (P > 0.05). 28 of 40 (70.0%) patients in the FJI group completed all six cycles of chemotherapy, while 12 (30.0%) patients interrupted the treatment due to chemotherapy-related toxicity. 39 patients in the PR group received chemotherapy, 19 (48.7%) of them completed 6 cycles of chemotherapy but 20 (51.3%) patients interrupted. There was a significant difference in the incidence rate of grade III/IV chemotherapeutic toxicity and completion rate of chemotherapy (P < 0.05).</p><p><b>CONCLUSIONS</b>Both functional jejunal interposition and Roux-Y operation are reasonable and safe procedures of digestive tract reconstruction. The incidence rates of emaciation, dumping syndrome and retention syndrome are lower in the patients with FJI, showing a better tolerance to adjuvant chemotherapy than Roux en-Y jejunal p type anastomosis.</p>

Surgical approach for upper gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the reasonable surgical approach for upper gastric cancer, surgical technique, and indications for combined resection of the spleen.</p><p><b>METHODS</b>Eight hundred and three patients with upper gastric cancer were operated in the Cancer Center of Sun Yat-Sen from December 1964 to December 2004, including 341 cases undergoing abdominal incision and 462 thoracotomy or abdomino-thoracic incision. Clinical data were analyzed retrospectively.</p><p><b>RESULTS</b>The operative time was significantly shorter in the abdominal incision group (170 vs. 220 min, P<0.01), as was the transfusion volume (200 vs. 650 ml, P<0.05). Positive resection margin was similar between the two groups (5.6% vs. 6.7%, P>0.05). There was no difference in overall postoperative complication rate (3.2% vs. 5.0%, P>0.05). Length of hospital stay was shorter in the abdominal incision group (21 vs. 26.6 days, P<0.05).</p><p><b>CONCLUSION</b>Selection of surgical approach should be based on the tumor characteristics. Abdominal incision should be the approach of choice where possible.</p>

Correlation analysis between loss of heterozygosity at chromosome 18q and prognosis in the stage-II colon cancer patients / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>Colorectal cancer is one of the most common malignant cancers in the world. Although the clinicopathologic staging is the golden criterion for the prognosis at present, the optimum prognostic criteria for colorectal cancer should be a combination of the clinicopathologic staging and the molecular markers. However, there are currently no molecular markers available for the prognosis of colorectal cancer. Several tumor-suppressor genes associated with colorectal cancer have been mapped at the 18q21-23 region. In this study we detected the frequency of loss of heterozygosity (LOH) at chromosome 18q and investigated the relationship between LOH and clinicopathologic features and its prognostic value for patients with stage II colon cancer.</p><p><b>METHODS</b>A total of 106 samples of tumor tissues and corresponding normal mucosa from patients with sporadic stage-II colon cancer were included in this study. All the samples were formalin-fixed and paraffin-embedded. DNA was extracted from tumor tissues and LOH of D18S474, D18S55, D18S58, D18S61 and D18S64 at chromosome 18q was analyzed using polymerase chain reaction (PCR), polyacrylamide gel-electrophoresis, and DNA sequencing method. Multivariate analysis for association between LOH and prognosis in colon cancer patients was performed with Cox proportional hazards regression model.</p><p><b>RESULTS</b>The median follow-up time was 68 months. For 106 patients, 5-year survival rate was 83.6%, which was associated with age and gross tumor type (P = 0.011 and 0.034, respectively). Among 102 patients who were eligible for LOH information, the overall frequency of LOH is 49.0% (50/102), and that of LOH at 5 microsatellite loci of D18S474, D18S55, D18S58, D18S61, and D18S64 was 30.2% (26/86), 23.4% (18/77), 28.6% (20/70), 35.0% (28/80), and 20.8%(15/72), respectively. The occurrence of LOH was significantly associated with tumor location and histopathologic grade (P = 0.023, 0.016 and 0.005, respectively). LOH was more frequent on the left-side, poorly-differentiated adenocarcinoma, and nonmucinous colon cancers. The occurrence of 18q-LOH was significantly associated with 5-year overall survival rate and disease free survival rate (P = 0.008 and 0.006, respectively). The occurrence of 18q-LOH at the loci of D18S474 and D18S61 was significantly associated with 5-year overall survival rate (P = 0.010 and 0.005, respectively). The multivariate analysis showed that only the occurrence of 18q-LOH was significantly associated with prognosis (P = 0.021).</p><p><b>CONCLUSIONS</b>There is a high occurrence of LOH at the loci of 18q. The expression of LOH is significantly associated with tumor location and histopathologic grade. The occurrence of 18q-LOH is an independent poor prognostic factor for the patients with stage-II colon cancer.</p>

Prognosis of 980 patients with gastric cancer after surgical resection / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>Although surgery is the only possible means to cure gastric cancer, the prognosis is often discrepant. The American Joint Committee on Cancer / International Union against Cancer (AJCC/UICC) published the TNM classification of Malignant Tumors (seventh edition) for gastric cancer recently. This study aimed to use this new edition staging system to investigate the prognostic factors for gastric cancer.</p><p><b>METHODS</b>The clinicopathologic data of 980 patients with gastric cancer treated by surgical resection in our hospital between January 2000 and December 2006 were analyzed retrospectively. The overall survival rate was determined by using Kaplan-Meier method and log-rank test was used to determine significance. The prognosis was analyzed using univariate analysis and multivariate analysis with the Cox proportional hazards model. The 6th and 7th edition AJCC/UICC TNM staging systems were used to compare the survival outcomes for the cohort of patients.</p><p><b>RESULTS</b>The overall 1-, 3-, 5-year survival rates for the whole group were 82.5%, 58.7%, and 52.6%. The 5-year survival rates for patients with pTNM stage I, II, III, and IV disease classified by the 7th edition staging system were 93.2%, 72.4%, 39.1%, and 5.2%, respectively. In both univariate analysis and Cox multivariate analysis, age, tumor site, tumor size, histological type, resection type, radical resection, lymphatic/venous invasion, depth of invasion, nodal status, metastasis, retrieved lymph nodes, metastatic lymph node ratio, and adjuvant chemotherapy were prognostic factors with these patients.</p><p><b>CONCLUSION</b>Compared with the 6th edition system, the new edition of TNM staging system for gastric cancer can accurately predict the survival after operation.</p>

Relationship between the number of lymph node detection and prognosis in stage II gastric cancer after D(2) dissection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the relationship between the lymph node count and prognosis in stage II gastric cancer.</p><p><b>METHODS</b>Retrospective analysis was performed for the 268 cases with gastric cancer who underwent parallel D(2) dissection between January 1990 and December 2006 in the Sun Yat-Sen Cancer Center. The Japanese Gastric Cancer Association(JGCA) 13th edition of pathological staging system was used to define stage II gastric cancer. Patients were followed up until December 2008. The Kaplan-Meier method and chi-square test were used for data analysis. All the data were analyzed using SPSS16.0 for Windows.</p><p><b>RESULTS</b>The average number of detected lymph nodes was 17.3+/-1.2. There were 109 patients with detected lymph node <15. The 1-, 3-, and 5-year survival rates were 92.7%, 67.8%, and 50.9%, respectively. The number of detected lymph node was > or =15 in 159 cases, and the 1-, 3-, and 5-year survival rates were 96.9 %, 81.0%, and 66.4%, respectively. The difference between two groups was statistically significant (P=0.003). Further analysis of the 199 cases with no lymph node metastasis (pN(0) group) showed that there were 95 cases with lymph nodes <15, and the 1-, 3-, and 5-year survival rates were 92.6%, 70.4%, and 55.9%, respectively. There were 104 patients with > or =15 lymph nodes, and the 1-, 3-, and 5-year survival rates were 97.1%, 84.4%, and 66.8%, respectively. The difference was also statistically significant (P=0.049). There were 69 cases with lymph node metastasis (PN(1) group), and the 1-, 3-, and 5-year survival rates of 14 patients with lymph nodes <15 were 92.9%,57.1%, and 34.3%, respectively. Comparing two groups, the survival rate was significantly different (P=0.034). There were 55 patients with > or =15 lymph nodes, and the 1-, 3-, and 5-year survival rates were 96.4%, 73.4%, and 63.8%. The difference was statistically significant (P=0.036).</p><p><b>CONCLUSION</b>In patients with stage II gastric cancer as defined by the JGCA 13th edition, the survival rate is better in patients with more than 15 detected lymph nodes as compared to those with less than 15.</p>

Pathologic characteristics of residual carcinoma at incisal edge after gastrectomy for gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the reason, features and preventive measures of residual carcinoma at incisal edge after gastric cancer operation.</p><p><b>METHODS</b>Clinical data of 108 cases with positive incisal margin(6.47%) from December 1964 to December 2004 in Cancer Center of Sun Yat-sen were summarized and analyzed retrospectively.</p><p><b>RESULTS</b>Positive incisal margin patients accounted for 6.5%(108/1670) of total gastric carcinoma cases during above period. There were 62 men and 46 women with median age of 54 years(ranged from 23 to 82). The residual carcinoma rates of incisal edge were 3.6%(48/1333) in radical resection group and 17.8%(60/337) in palliative resection group respectively(P=0.000). Also, the residual carcinoma rates were 2.3%(3/129) in early group, 6.8(105/1541) in advanced group(P=0.046), 4.5%(37/815) in distal gastrectomy group and 8.0%(55/689) in proximal group respectively(P=0.000). Residual carcinomas were related with pTNM stage, Borrmann type, tumor size, differentiation and invasion depth(P<0.05).</p><p><b>CONCLUSIONS</b>Superior gastric carcinoma, Borrmann III(, IIII( type advanced cancer, tumor diameter > or =5 cm, poor differentiation or undifferentiated type and serosa invaded easily result in residual carcinoma at incisal edge. The radical preventive measure is to ensure that incisal edge ought to exceed 5 cm apart from the tumor.</p>

Comparative study on clinical characteristics of gastric carcinoma between young and elderly patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the clinical characteristics of gastric cancer between young and elderly patients,and bring forward corresponding countermeasures.</p><p><b>METHODS</b>Clinical characteristics, treatment and prognosis between 79 young (<or= 45 years old) and 120 elderly (>or= 65 years old) patients were compared.</p><p><b>RESULTS</b>The constituent ratio of gender between young and elderly group was not significantly different (P=0.226). There was no particularity of early symptom in young patients, but they had shorter course of disease (165 d vs 400 d, P=0.029) and more frequent inferior part of cancer (49.4% vs 41.7%, P=0.038) as compared to elderly patients. There was significant difference between two groups in pathological stage ratio (P=0.027). The median total survival time of young and elderly patients was 1006 d and 530 d respectively, which was not significantly different (P=0.108). Furthermore, median survival time of young and elderly patients after radical resection were 1197 d and 919 d respectively, and the difference was not significant as well (P=0.242).</p><p><b>CONCLUSIONS</b>Characteristics of young patients with gastric cancer are lower incidence, larvaceous symptoms, more malignancy and quick development, which still remain general features of gastric cancer. By correct therapy, the efficacy of above young patients is similar to elderly patients. The key to improve prognosis is to further fortify cognition for gastric cancer and elevate early diagnostic rate.</p>

Long-term results of surgical treatment of stomach cancer: clinical experience of forty years from Sun Yat-sen University Cancer Center / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the approaches to improve therapeutic effect of stomach cancer by analysis of the long-term results of surgical treatment of this disease.</p><p><b>METHODS</b>Prognostic factors of stomach cancer were analyzed by Cox multivariate regression model based on clinical data of 2561 stomach cancer cases who underwent surgical treatment from 1964 to 2004 at Sun Yat-sen University Cancer Center. Survival rates were calculated by life table method.</p><p><b>RESULTS</b>Gastrectomy was performed for 1950 cases with resectability of 76.1%, among which there were 1192 cases of curative resection (46.5%) and 758 cases of non-curative resection (29.6%). The other 611 cases of palliative operation included bypass procedures and laparotomy. Operative mortality of all cases was 0.8% and morbidity was 5.1%. For all cases the 1-, 3- and 5-year survival rate was 52.4%, 38.6% and 35.5%, respectively. The stage-specific 5-year survival rate was 86.8% (Stage I), 58.7% (Stage II), 28.4% (Stage III) and 7.6% (Stage IV), respectively. The 5-year survival after curative resection in the period of 40 years was 45.5%, and increased to 52.7% in the last two decades and 61.8% in recent decade. Stage-specific case proportion during the earlier two decades was 1.4% (Stage I), 10.6% (Stage II), 23.1% (Stage III) and 64.9% (Stage IV), respectively, and that during the recent two decades was 9.3%, 18.5%, 35.3% and 36.8%, respectively. The 5-year survival rate of cases during the earlier two decades was 18.0% and increased to 37.5% during the recent two decades. Multivariate analysis indicated that main prognostic factors of stomach cancer included TNM staging, curative resection and multidisciplinary treatment.</p><p><b>CONCLUSIONS</b>Early detection and curative resection were the most important measures to improve therapeutic effect of stomach cancer. A surgery-predominant multidisciplinary treatment individualizing biological characteristics of tumor, staging of disease and tumor site will contribute to improvement of therapeutic effect of stomach cancer.</p>