Factors affecting the safety and efficacy of peroral endoscopic myotomy for achalasia / 南方医科大学学报

<p><b>OBJECTIVE</b>To identify the factors that affect the safety and efficacy of peroral endoscopic myotomy (POEM) for treatment of achalasia.</p><p><b>METHODS</b>Data of consecutive patients undergoing POEM for confirmed achalasia between December, 2010 and December, 2015 were collected, including the procedure time, approach of tunnel entry incision, approach of myotomy, complications and follow-up data.</p><p><b>RESULTS</b>Among the total of 439 patients enrolled, the overall complication rate was 28.7% (126/439). Treatment success (Eckardt score≤3) was achieved in 94.5% of 364 patients followed up for a median of 6 months (1-48 months), and the mean score was reduced significantly from 6.7∓1.5 before treatment to 1.2∓1.1 after the treatment (P<0.05). Logistic regression revealed that the year when POEM was performed and the approach of entry incision were two significant factors contributing to complications: with the year 2015 as the reference, the odds ratio (OR) was 9.454 (95% CI: 2.499-35.76) for the years before 2011, 2.177 (95% CI: 0.794-5.974) for 2012, 3.975 (95% CI: 1.904-8.298) for 2013, and 1.079 (95% CI: 0.601-1.940) for 2014; with the longitudinal entry incision as the reference, the OR was 0.369 (95% CI: 0.165-0.824) for inverted T entry incision and 0.456 (95% CI: 0.242-0.859) for transverse entry incision. The approach of myotomy was the significantly associated with symptomatic relapse: with full-thickness myotomy combined with indwelling an anti-reflux belt as the reference, the OR was 0.363 (95% CI: 0.059-2.250) for gradual full-thickness myotomy, 2.137 (95% CI: 0.440-10.378) for circular muscle myotomy, and 4.385 (95% CI: 0.820-23.438) for circular muscle myotomy in combination with balloon shaping; the recurrence rate was 0 with a full-thickness myotomy.</p><p><b>CONCLUSION</b>The complication rates of POEM appears to decrease over time, and an inverted T entry incision is the best choice for controlling the complications. Gradual full-thickness myotomy is an excellent approach for treatment of achalasia in terms of the relapse rate, procedure time and the incidence of reflux esophagitis.</p>

Factors influencing survival of patients with cancer of the pancreatic head after resection / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this cohort study was to investigate the clinical outcome and prognostic factors in patients after resection for ductal adenocarcinoma of the pancreatic head.</p><p><b>METHODS</b>patients with pancreatic head cancer undergoing curative resection (R0) between 1997 and 2002 were included in this study. Univariate and multivariate analyses were performed to examine factors affecting clinical outcome and recurrence of the cancer.</p><p><b>RESULTS</b>Surgical procedures consisted of 58 (43.3%) extended pancreaticoduodenectomies (EPD), 47 (35.1%) pancreaticoduodenectomies (PD) and 29 (21.6%) pylorus-preserving pancreaticoduodenectomies (PPPD). The results showed that 81.3% (109/134) of patients had a recurrence during the study period, mainly retroperitoneal combined with distant metastasis (53.7%). The median postoperative survival time was 24.7 months. The 1-, 3- and 5-year overall survival rates for the study population were 67.1%, 38.5% and 17.6%, respectively. Univariate analysis showed that preoperative abdominal and/or back pain, tumor size > 2 cm, lymph node involvement and vascular invasion, and CA19-9 level were all significant predictors for poor survival. Multivariate analysis also showed that preoperative abdominal and/or back pain, tumor size > 2 cm, lymph node involvement and vascular invasion were all significant predictors for poor survival.</p><p><b>CONCLUSION</b>Our results suggest that preoperative abdominal and/or back pain, tumor size > 2 cm, lymph node involvement and vascular invasion are significant predictors for poor survival in patients with pancreatic head cancer.</p>

Analysis of the surgical outcome and prognostic factors for hilar cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the therapeutic strategies and prognostic factors which influence on clinical outcome of hilar cholangiocarcinoma.</p><p><b>METHODS</b>A total of 144 patients with hilar cholangiocarcinoma underwent operation between January 1990 and December 2005 were analyzed, including 102 males and 42 females with 36- 74-years-old. All patients underwent resection among which 86 cases (59.7%) had an R0 resection (negative histologic margins), 34 cases (23.6%) had an R1 resection (positive histologic margins), 24 cases (16.7%) had an R2 resection. The Bismuth-Corlette classification of group R0 and R1: 28 cases (23.3%) in type I , 49 cases (40.8%) in type II, 10 cases (8.3%) in type III A, 19 cases (15. 8%) in type III B and 14 cases (11.7%) in type IV. The TNM stages of group R0 and R1: 19 cases (15.8%) in stage I, 80 cases in stage II (66.7%), 16 cases in stage III (13.3%), 5 cases in stage IV (4.2%). In group R0 and R1, there were 41 cases with well differentiated and 79 cases with moderately and poorly differentiated, 62 cases (51.7%) with negative lymph nodes and 58 cases (48.3%) with positive lymph nodes, 42 cases in stage T1 and 78 cases in stage T2-3, 86 cases with negative blood vessel metastasis and 34 cases with positive blood vessel metastasis.</p><p><b>RESULTS</b>The median survival time was 46.8 months after R0 resection, 18.3 months after R1 resection, and 11.2 months after R2 resection. The 1-, 3- and 5-year cumulative survival rates of the patients were 60.2%, 36.1% and 29.4%. Survival rates after resection in patients with negative lymph nodes (n = 62) were significantly longer than that in those with positive lymph nodes (n = 58) (P < 0.01). The T stage system predicted respectability and the likelihood of an R0 resection and correlated with survival (P = 0.030). Patients requiring portal vein resection had a worse prognosis than those without vascular resection (P = 0.047) but still survived longer than patients who were unresectable (P < 0.01).</p><p><b>CONCLUSIONS</b>Negative histologic margins, concomitant partial hepatectomy, and well-differentiated tumor histology are associated with improved outcome after all hilar cholangiocarcinoma resections. In patients who underwent an R0 resection, concomitant partial hepatectomy is the only independent predictor of long-term survival.</p>

Comparison of prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To compare the prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection.</p><p><b>METHODS</b>413 patients receiving curative resections at Tianjin Cancer Hospital for small HCC (< or = 3 cm) from January 1997 to December 2003 were divided into four groups: HCV only (n = 75), HBV only (n = 251), HBV and HCV (n = 33), and neither HBV nor HCV (NBNC, n = 54). The preoperative status and postoperative recurrence were recorded. Survival analysis were used to assess the impact of HBV/HCV status on HCC recurrence.</p><p><b>RESULTS</b>Patients with HCV were associated with older age, lower mean preoperative platelet counts and albumin levels, higher mean prothrombin time, alanine aminotransferase and total bilirubin levels. Tumors in patients with HCV are multinodular and less differentiated, and were associated with a higher incidence of vascular invasion and cirrhosis. During the follow-up, the HCV group showed a higher incidence of intrahepatic recurrence and multiple recurrent lesions than the other patients.</p><p><b>CONCLUSIONS</b>HCC patients with HCV infection tended to be older, and were characterized by more severe cirrhosis and higher incidence of tumor multinodular. The statistically significant determinants of reoccurrence in patients with small HCC were HCV infection, presence of vascular invasion and multiple tumors.</p>

Regional pancreaticoduodenectomy with portal vein resection in patients with pancreatic head carcinoma / 中国普通外科杂志

Objective To evaluate operative efficacy in regional pancreaticoduodenectomy with mesenteric-portal vein resection and graft reconstruction using iuternal jugular vein for pancreatic head carcinoma.Methods From Jan 2000 to Jan 2003,6 patients with pancreatic head tumors and mesenteric- portal vein involvement underwent regional pancreatieoduodenectomy with mesenteric-portal vein reseetion and vascular reconstruction using internal jugular vein.Results Surgery was successful in all 6 patients. Postoperative pathology revealed that mesenteric vein or portal vein were invaded by tumor in all cases. Survival time ranged from 17 to 49 mouths.The median survival was 23.4 months.Two cases have survived over 3 years and one of them was alive 49 months postoperatively without recurrence.Conclusion The regional pancreaticoduodenectomy with tumor invaded mesenteric-portal vein resection and graft reconstruction by using internal jugular vein renders a longer survival in metastasis-negative patients of pancreatic head adenocarcinoma.