Comparison of gastric-jejunum pouch anastomosis and Billroth-II reconstructions after distal gastrectomy: a propensity score matching analysis

Purpose@#Our study aimed to make a propensity score matching (PSM) analysis on the clinical application of gastricjejunum pouch anastomosis (GJPA) and Billroth-II anastomosis after distal gastrectomy. @*Methods@#We collected clinical data from 249 patients who received distal gastrectomy from January 2016 to July 2020. According to the reconstruction method used, all patients were divided into the Billroth-II group and the GJPA group. Clinical data and operation complications were analyzed. @*Results@#The clinical characteristics of the 2 groups were comparable after PSM. In the Billroth-II group, the incidence rate of delayed gastric emptying was higher than that in the GJPA group. Fewer patients suffered reflux gastritis in the GJPA group. The RGB (residue, gastritis, and bile) scores related to the severity of bile reflux into the remnant stomach, gastritis, and residue were higher in the Billroth-II group. Postoperative nutritional status and Visick classification demonstrated that postoperative subjective feelings in the GJPA group were improved significantly. @*Conclusion@#The application of GJPA in reconstruction after distal gastrectomy is safe, economical, and reliable. This reconstruction improved the quality of life of patients. It is worth popularizing widely in clinical settings.

Dose reconstruction method for photon external radiation accident based on human voxel phantom / 中华放射医学与防护杂志

Objective To study the method of dose reconstruction in human body under the photon external radiation accident condition,and to verify the accuracy of the method for the local dose distribution.Methods Based on the open source Monte Carlo tool kit Geant 4 and using the human voxel phantom recommended by ICRP Publication 103,the dose reconstruction method under the condition of external radiation accident was studied to evaluate the average absorbed dose,organ absorbed dose and local dose distribution.To validate the code,several irradiation experiments were implemented in some standard radiation fields by putting TLDs in the tissue equivalent physical phantom ART.A voxel phantom was used to reconstruct the radiation doses,which was created based on the CT scan image of the ART phantom with resolution of 1.57 mm× 1.57 mm× 10.00 mm.The result of experiment were compared with those of dose reconstruction simulation.Results The relative uncertainty of the measured values was 10.9％.The relative uncertainty of the dose reconstruction simulation values was 7.10％ at the non-tissueinterface area and 16.6％ at the tissue-interface area.For 451 measuring points,the average of the simulated value divided by the measured value was 0.972,with the standard deviation of 0.083 8.In the range of 0.95-1.05,0.90-1.10 and 0.80-1.20,and the proportions were 49.2％,79.4％ and 96.4％,respectively.Conclusions The method of Monte Carlo dose reconstruction based on human voxel phantom meets the accuracy requirement of actual uses both at the whole body or organ level and at the local dose distribution level.It can be used as a powerful tool for dose assessment of the exposed people in an external radiation accidents and provide support for diagnosis and treatment.

Efficacy comparison of lymph node dissection patterns of the reverse and the cabbage in hand-assisted laparoscopic D2 radical gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the clinical efficacy of the lymph node dissection patterns of the reverse and the traditional cabbage in hand-assisted laparoscopic D2 radical gastrectomy (HALG).</p><p><b>METHODS</b>From December 2010 to October 2013, 194 patients with HALG in Chengdu Military General Hospital were enrolled in this study. According to the pattern of lymph node dissection, 108 patients were performed with the reverse procedure which took spleen as starting point, from left to right, and 86 patients were performed with the traditional cabbage procedure which took the abdominal cavity as the center, from both sides to middle. A retrospective comparative analysis was made on the intra- and post-operative data between the two groups.</p><p><b>RESULTS</b>All the patients were successfully performed with HALG, and no peri-operative death occurred. There were no significant differences in the incision length [(7.0 ± 0.2) cm vs. (6.9 ± 0.3) cm], the operative time [(170.9 ± 33.8) minute vs. (174.6 ± 22.4) minute], dissected lymph node number (17.6 ± 7.5 vs. 17.1 ± 5.8) and post-operative complications [(6.5%(7/108) vs. 8.1%(7/86)] between the reverse group and cabbage group (all P>0.05). However, less blood loss [(204.6 ± 98.2) ml vs. (259.1 ± 122.6) ml, P<0.01] and shorter postoperative hospital stay [(9.0 ± 1.7) day vs. (10.5 ± 4.0) day, P<0.01] were observed in reverse group as compared to cabbage group. During 1 to 6 months follow-up, no death case was found in reverse group, while 1 case died due to upper gastrointestinal bleeding 48 days after operation in cabbage group.</p><p><b>CONCLUSION</b>Efficacy is similar between the two HALG procedures in lymph node dissection, while reverse procedure has certain advantages, such as less blood loss and faster recovery.</p>

Expression of VEGF-C and it's relationship with clinical pathologic characteristics in rectal cancer / 中华普通外科杂志

Objective To study the expression of VEGF-C and it's relationship with pathologic characteristics in rectal cancer.Method In this study 82 patients of mid to low rectal cancer underwent radieal resection from December 2007 to August 2008.Tumor tissues and lymph nodes were studied by immunohistochemical staining for VEGF-C expression in the tumor tissue and CK20 expression in D3 lymph nodes.Results were compared with the pathological results of mesenterium lymph nodes to explain the relationships between VEGF-C expressions and clinical pathologic characteristics.Data were analyzed with Chi square test.Result As for the expression of VEGF-C.significant differences were found between tumor stages(X~2=8.529,P<0.05)and between positive and negative lymph node metastasis(X~2=4.712,P<0.05).but there was no difference between that of mesenterium lymph node metastasis and D3 lymph node micrometastasis(X~2=0.017,P>0.05). Conclmion In rectal cancer,VEGF-C expression is correlated with tumor stage,type,metastasis and micrometastasis of lymph node.

VEGF-C,VEGF-D pathways and tumor lymphangiogenesis / 国际外科学杂志

Tumor metastasis to sentinel lymph nodes represents the first step of tumor dissemination in most human cancers and serves as a major prognostic indicator for disease progression.Recent studies have revealed that tumor lymphangiogenesisis correlated with lymph node metastasis in experimental cancer models and in several types of human Cancers.Metastatic tumor cells may continue to promote lymphatic vessel growth even after their metastasis to sentinel lymph nodes,likely promoting further cancer spread.Vascular endothelial growth factor-C(VEGF-C)and VEGF-D are the first specific lymphangiogenesis factor identified,and a large number of clinical studies have shown a correlation between tumor expression of VEGF-C or VEGF-D and lymph node metastasis.Additional tumor lymphangiogenesis factors have been recently identifled,including VEGF-A.Importantly,blockade of the VEGFR-3 pathway by specific antibodies,by soluble receptor constructs,and by small molecule kinase iubibitors efficiently inhibits experimental tumor lymphangiogenesis and metastasis and might also represent a novel therapeutic avenue for the treatment of human cancers.

Lymphnode micrometastasis for rectal cancer / 国际外科学杂志

Lymph node metastasis is a main route of metastasis for rectal cancer,and skip metastasis is an im portant characteristic.Many cases were found metastasis or micrometastasis in lateral or upper lymph node before the definite metastasis in mesenterium lymph node.To exactly check and diagnose the lymphnode metastasis can help manage CLIN,and influence the prognosis.In reeent years,progress has achieved in the study of lymphnode micrometestasis,and it is really a promotion for the management of rectal cancer.

Influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer / 中华消化外科杂志

Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer. Methods From August 2006 to August 2007, 119 male patients with rectal cancer who had been admitted to Southwest Hospital were assigned to open surgery group (n=59) and laparoscopic group (n=60) according to the random number table. Three months after the operation, the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS). Differences in measurement data were compared with paired t test. Results There was no significant difference in IPSS between laparoscopic group (10.9±2.9) and open surgery group (11.5±3.1) (t=-1. 309, P>0.05). The maximum flow rate, voided volume, residual urine volume, detrusor contraction pressure and maximum urethral pressure were 15.2 ml/s, 150.1 ml, 6.1 ml, 43.3 cm H2O (1 cm H2O=0.098 kPa) and 77.5 cm H2O in laparoscopic group, and 15.0 ml/s, 140.9 ml, 6.4 ml, 45.6 cm H2O and 72.3 cm H2O in open surgery group, with no statistical difference between the 2 groups (t=1.22, -2.12, -1.73, -1.35, -1.64, P>0.05). Conclusions Laparosceopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function, and its efficacy is comparable to that of open surgery.

The effects of after surgical treatment on urinary and sexual function of male rectal cancer patients / 国际外科学杂志

Urinary and sexual dysfunction is common complication after surgical treatment for rectal cancer patients,and many studies were carried out for these complications.This article reviewed the literatures on clinical research of urogenital function after operations of rectal cancer.

Laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation for rectal cancer / 中华消化外科杂志

Objective To investigate the feasibility of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation for rectal cancer.Methods The clinical data of 34 patients with rectal cancer who had been admitted to OUr hospital from January 2007 to December 2007 were retrospectively analyzed.All patients underwent laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation.The operation time,lymph node dissection,postoperative complications were assessed.The erectile function of male patients and the short-term outcome of the operation were evaluated.Results All patients were successfully operated on,and no conversion Was required.The mean operation time,blood loss,number of lymph node dissected,time of catheterization,mearl volume of residual urine and CEA were(265+46)minutes,(123±27)ml and 19±3,(5.5±1.6)days,(22.5±7.8)ml and(8.0±4.6)U/L,respectively.The incidence of postoperative complications and male sexual dysfunction were 9%(3/34)and 14%(3/21),respectively.No local recurrence or distal metastasis Was observed at the end of August 2008.Conclusions Laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation for rectal cancer is relatively safe and feasible.