Adaption of surgical procedure in the treatment of submucosal esophageal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVES</b>To evaluate the efficacy and advantage of minimally invasive esophagectomy for surgical treatment of submucosal esophageal cancer compared to conventional open procedure.</p><p><b>METHODS</b>Clinical data of consecutive 168 patients with stage T1b submucosal esophageal cancer undergoing minimally invasive esophagectomy (MIE, esophagectomy by thoracoscope, stomach freeing by laparoscope or open abdomen, cervical esophagogastric anastomosis) or conventional open esophagectomy (OE) at the Shanghai Chest Hospital between January 1, 2012 and December 31, 2014 were reviewed retrospectively. Intraoperative and postoperative information was compared between the two groups.</p><p><b>RESULTS</b>Both groups were equally stratified by sex, body mass index and age. No patient of MIE group was transferred to open operation. As compared to the OE group, the MIE group had significantly more harvest lymph nodes (median 12 vs. median 9, P=0.004), lower rate of postoperative pneumonia [5.8% (4/69) vs. 21.2% (21/99), P=0.011] and pleural effusion [8.7% (6/69) vs. 23.2% (23/99), P=0.027], and shorter hospital stay (median 11 d vs. median 14 d, P=0.041), but positive margin was found in 1 case. There were no significant differences of respiratory failure, pneumothorax, atrial arrhythmia, pulmonary embolism, recurrent nerve palsy, anastomotic leak, reoperations and 30-day mortality between the two groups. Multivariate logistic analysis revealed recurrent nerve palsy, anastomotic leak and surgical approach were found to be the main factors of hospital stay within postoperative 12 days, while leakage when the in-hospital time more than 12 days. Kaplan-Meier analysis showed that the surgical approach was the independent factor of hospital stay, MIE could shorten the hospital stay (P=0.013).</p><p><b>CONCLUSION</b>MIE should be considered as the standard approach in the treatment of T1b submucosal esophageal cancer.</p>

Relationship between expression of DAS-1 protein in intestinal metaplasia and gastric cardia adenocarcinoma / 中华消化杂志

Objective To investigate the relationship between expression of DAS-1 in gastric cardia intestinal metaplasia(CIM)and gastric cardia adenocarcinoma (GCA). Methods The cancerous tissues and CIM tissues (2 cm apart from caneer) obtained from 65 patients with GCA were examined for the expression of DAS-1 protein using immunohistoehemistry. The CIM tissues (<2 cm below Z line) obtained from 15 outpatients and inflammatory mucosa from 25 outpatients were also examined for expression of DAS-1 protein. Results The type Ⅲ IM was accounted for 55.4% (36/65) in GCA patients, which was significantly higher than that in outpatients [13.3% (2/15), P<0.01]. The positive rate of DAS-1 expression in cancerous tissues [78.5 % (51/65)] was also significantly higher than that in CIM tissues [38.8 %(30/80), P<0.01]. The expression of DAS-1 protein in IM tissues was gradually increased from type Ⅰ (0%) to type Ⅲ (71.1%) with positive correlation (P<0.01). Conclusions The type Ⅲ IM with over-expression of DAS-1 is closely related to GCA, which might be one of important precancerous lesions for GCA.