Therapeutic effects of different treatments of hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To analyze the clinical data of patients with hilar cholangiocarcinoma (HCCA),and to compare the therapeutic effects of different methods on treating these patients.Methods The clinical data of 101 patients with HCCA in China-Japan Union Hospital of Jilin University were analyzed.Results The overall 1-year and 2-year survival rates in the radical operation group were 95.5％ and 40.9％,respectively.There was a significant difference between the radical operation group and the palliative resection group (P ＜ 0.05).The overall 1-year and 2-year survival rates in the palliative resection group were 75.0％ and 16.7％,respectively,which were much better than those in patients treated with PTCD,biliary stent on open abdominal biliary drainage (P ＜ 0.05).There were no significant differences among the PTCD,biliary stent and open abdominal biliary drainage groups (P ＞ 0.05).Conclusions Radical HCCA resection is still the best and the first choice treatment for patients with HCCA.The therapeutic effects of radical operation were much better than those of palliative resection,biliary stent,PTCD and open abdominal biliary drainage.

Survival analysis of 345 patients with colorectal cancer undergoing palliative resection / 中华消化外科杂志

Objective To investigate the related factors affecting prognosis of patients with colorectal cancer undergoing palliative resection.Methods The clinical data of 345 patients with colorectal cancer who underwent palliative resection at the First Affiliated Hospital of Guangxi Medical University between January 2007 and December 2011 were retrospectively analyzed.Patients selected the emergent operations or restrictive operation based on the conditions of patients,and then received chemotherapy,radiotherapy and biotherapy.Chemotherapy regimens included FOLFOX4 (5-FU/CF + oxaliplatin) regimen,XELOX (capecitabine + oxaliplatin) regimen and FOLFIRI (5-FU + CF + irinotecan) regimen.Biotherapy regimens included molecular targeted therapies using bevacizumab and cetuximab.The follow-up was applied to patients by outpatient examination,telephone interview and correspondence once every 3 months up to March 1,2014.The survival curve was drawn by the Kaplan-Meier method.The survival rate was analyzed using the Log rank test.The multivariate analysis was done using the COX regression model.Results Of the 1 930 patients,345 patients received palliative resection with a percentage rate of 17.876％.Among the 345 patients,104 patients received emergent operations and others received restrictive operations.After operation,178 patients received adjuvant treatment,FOLFOX4 regimens were done on 85 patients,XELOX regimens on 32 patients,FOLFIRI regimens on 20 patients,radiotherapy on 17 patients and molecular targeted therapies on 24 patients.Seven patients died in the perioperative period and other patients were followed up for 3.0-82.0 months with a median time of 14.0 months.The 1-,3-and 5-year survival rates and the mean survival time were 49.57％,11.88％,6.38％ and 22.6 months,respectively.The results of univariate analysis showed that the CEA levels,bowel obstruction,primary tumor resection,peritoneal implantation,distal metastasis,lymph node metastasis,tumor differentiation,postoperative adjuvant therapy were related factors affecting the prognosis of patients undergoing palliative resection (x2=3.742,18.795,37.641,13.470,4.228,5.835,4.108,6.875,P ＜0.05).The results of multivariate analysis showed that the bowel obstruction,without primary tumor resection,peritoneal implantation,low-differentiation of tumor and without postoperative adjuvant therapy were the independent risk factors affecting the prognosis of patients undergoing palliative resection (RR =1.674,2.273,1.947,1.582,1.342,95％ confidence interval:1.193-2.485,1.646-4.376,1.497-3.587,1.184-2.382,1.032-2.074,P ＜ 0.05).Conclusion The low-differentiation of tumor,peritoneal implantation,bowel obstruction,without primary tumor resection and without postoperative adjuvant therapy are the independent risk factors affecting the prognosis of patients with colorectal cancer undergoing palliative resection.

Clinical Outcome of Positive Margin of Postgastrectomy with Adenocarcinoma of Stomach / 고신대학교의과대학학술지

OBJECTIVES: Many investigators have recommended adequate resection margin and lymphadenectomy for radical curative resection. The aim of this study is to evaluate clinical characteristics of positive resection margin (proximal or distal) of postgastrectomy in advanced gastric cancer. METHODS: We studied 17 patients with gastric cancer who were diagnosed positive resection margin by intraoperative frozen biopsy or permanent biopsy report from January 2005 to December 2007, retrospectively. Surgical margin monitored by endoscopy. RESULTS: Distal gastrectomy was performed in 13 patients and total gastrectomy in 4. Gastrectomy with combined resection including splenectomy was performed in 3, distal pancreatectomy in 2, transverse colon segmental resection in 1, and cholecystectomy in 2. Positive Proximal margin was found in 12, positive distal margin in 3, and both in 2. Palliative chemotherapy was performed in 8 patients. Postoperative follow up endoscopy was established in only 8 patients. Malignant results from endoscopic biopsy in gastroenteric or esophagoenteric anastomotic line were proven in 2 patients during follow up. 9 patients were not performed follow-up endoscopy. Among total 17 patients, 2 patients are alive. Fifteen patients died of aggravation of disease in 13 and postoperative complication in 2. CONCLUSIONS: Although positive surgical margin in far advanced gastric cancer were found, it can consider that does not further resection to obtain microscopic clear anastomotic margin.

Analysis of surgical therapy on 43 cases of hepatic alveolar echinococcosis / 中华肝胆外科杂志

Objective To study the operative techniques and the surgical results of hepatic alveolar echinococcosis. Methods Forty three patients with hepatic alveolar echinococcosis treated in our Hospital from 2000 to 2008 were studied retrospectively. They were divided into two groups: radical resection group (19 cases) and palliative resection group (24 cases). Results There were 1 surgeryrelated death, 2 patients with remote metastases, 2 patients with intrahepatic dissemination, 4 patients with recurrent jaundice and 3 patients with cholangitis in the palliative resection group. There were 3 patients with biliary fistula, 1 patient with cholangitis and 3 patients with emaciation in the radical resection group. Among the 30 patients followed-up for ≤3-≤8 years, 10 patients died in the palliative resection group and the long-term survival rate was 28.5% (4/14). One patient died from gastric cancer in the cardiac in the radical resection group and the long survival rate was 93. 7%(15/16). Conclusions The first choice of treatment for hepatic alveolar echinococcosis is radical resection. Patients could be cured by radical resection. Palliative surgery is an option for patients not manageable otherwise.

The effect of palliative resection on incurable colorectal cancer survival / 中国医师进修杂志

Objective To quantify the benefit of primary Pdmor removal in patients with differently presenting incurable coloreetal cancer,while no other therapy combined.Methods One hundred and forty-three consecutive patients were operated for incurable colorectal cancer(91 undergoing resective and 52 non-resective procedures),with the purpose of comparing homogenous populations and of identifying whether the patients got benefit from primary tumor resection.Results In patients with resectable primary tumors,resective procedures were associated with longer median survival than non-resective procedures(10 months vs 3 months),patients with distant spread without neoplastic ascites/implanting metastasis got benefit from primary tumor removal(P＜0.01).The complication of resective procedures was not significantly differ-ent from that of non-resective procedares(P＞0.05).Conclusion Palliative resection of primary colorectal cancer should be pursued in patients with unresectable distant metastasis whenever the primary tumor is technically resectable.

Clinical study on operative effect of surgical treatment for hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To investigate the clinical effect of surgical treatment for hilar cholangio-carcinoma. Methods The clinical data of 89 patients with hilar cholangiocarcinoma surgically treated in our hospital were retrospectively analyzed. They were divided into 3 groups: radical resection(group A,n=23),palliative resection (group B,n=44) and external drainage operation (group C,n=22). Complications,operative mortality,survival rate and posttreatment quality of lire were compara-tively analyzed among the 3 groups. Results The rate of complications was significantly higher in group A than in group C (P<0.05). There was no marked difference in operative mortality between group A and group B (P>0.05). The 1-,2-and 3-year survival rates and scoring of quality of life were remarkably higher in group A than in other 2 groups (P<0. 001 and 0. 05). Conclusion Radical re-section of hilar cholangiocarcinoma can improve the long-term survival and significantly enhance quality of life of the patients after operation. For patients receiving unradical resection, palliative surgical man-agement can improve the long-term survival and enhance quality of life.

A Clinical Analysis of Stage IV Gastric Cancer

From 1988 to 1994, 62 of 262 patients admitted to the Boramae City Hospital with gastric cancer were diagnosed as stage IV. Among them, 5 patients were lost during follow-up, so we analyzed 57 patients retrospectively. This study elucidates whether a palliative resection offered any survival advantage compared to non-resectional treatment. Of the 57 patients, 7 (12%) received a non-curative resection, 36 (63%) a bypass procedure, and 14 (25%) an exploratory laparotomy. There were no operative mortalities and morbidity. Univariate survival analysis demonstrated that the median survival and the 1- and the 2-year survival rates were significantly higher in the resected patients. The median survival and the 1- and the 2-year survival rates were 15 months, 71%, and 57% with a non-curative resection, 7.3 months, 25%, and 8% with bypass procedure, and 6.3 months 33%, and 17% with an exploratory laparotomy. To perform the analysis within relatively homogeneous groups, patients with different operations were further stratified into two groups according to the spread of disease: local (T4) and distant (M1) spread. The median survival of the T4 group was 11.4 months whereas that of the M1 group was 6 months. Although there was no statistical significance in this study, it is noteworthy that, compared to a bypass procedure and a exploratory laparotomy, a non-curative resection seems to have a survival benefit in the M1 group (median survival: 528 days vs 131 days and 182 days, p=0.0926). In conclusion, although this study has the limitations of a retrospective study and a univariate analysis performed without consideration of basic patient characteristics (age, weight loss, nutritional status, etc.), palliative resection seems to be justified in patients with stage IV gastric cancer if it is performed with acceptably low mortality and morbidity.

Palliative Resection for Incurable Colorectal Cancer

Despite a recent trend toward increased screening and public awareness for colorectal cancer, 30% of patients present with incurable disease. This study was designed to identify objective criteria that might help surgeons decide which patients with incurable colorectal cancer will benefit from palliative resection. Among 33 patients considered incurable colorectal cancer, twenty one patients underwent palliative resection and twelve patients had bypass surgery. Incidence of postoperative complication after palliative resection was 61.9%(13 cases), and after bypass surgery was 58.3%(7 cases). Among patients treated by palliative resection, one patient required reoperation for postoperative bleeding. The operative mortality after palliative resection was 19%(4 cases), and after bypass surgery was 25%(3 cases). The median survival was 11.4 months for patients treated by palliative resection, and was 9.7 months for patients treated by bypass surgery. These results show that palliative resection can be done safely and effectively in patients with incurable colorectal cancer. We believe this approach improved the quality of the remaining life in these patients.