Skip metastasis at the esophageal resection margin in radical gastrectomy: clinical characteristics of 30 cases / 中华胃肠外科杂志

Objective: To summarize the clinical characteristics of patients with skip metastasis at esophageal resection margin during radical gastrectomy. Methods: This is a descriptive study of case series. Relevant data from 2006 to 2022 were collected from two major gastric cancer consultation and treatment centers: Nanjing Drum Tower Hospital and Jinling Hospital.Characteristics, surgical approach, number of dissected lymph nodes, immunohistochemical staining, and pathological staging were summarized and analyzed. The distribution of residual tumor cells at the esophageal margins was further analyzed at the cellular and tissue levels. Skip metastasis at the esophageal resection margin was defined as a negative esophageal margin with a positive margin in the cephalad donut. Results: Thirty (0.33%, 30/8972) eligible patients, 24 (80.0%) of whom were male, were identified in the two centers. The mean age was 63.9±11.0 years. Seventeen (56.7%) of these patients had papillary or tubular adenocarcinomas, including 13 (43.3%) poorly- and four (13.3%) moderately-differentiated tumors; four (13.3%) had signet-ring cell carcinomas; four (13.3%) mucinous adenocarcinomas; three (10.0%) mixed adenocarcinomas, including two with poorly-differentiated tubular adenocarcinomas mixed with signet-ring cell carcinoma and mucinous adenocarcinoma; and one had a poorly differentiated tubular adenocarcinoma mixed with signet-ring cell carcinoma. Two patients (6.7%) had other types of cancer, namely adenosquamous carcinoma in one patient and undifferentiated carcinoma in the other one. The predominant tumor sites were the lesser curvature (n=26, 86.7%) and the cardia (n=24, 80.0%). The mean tumor diameter was 6.6 cm, mean distance between tumor and esophageal resection margin was 1.5 cm, and proportions of tumor invasion into the dentate line, nerves, and vessels were 80.0% (24/30), 86.7%(26/30), and 93.3% (28/30), respectively. The mean number of lymph nodes resected was 20.4±8.9. The pathological stage was mainly T4 (n=18, 60.0%) and N3 (n=21, 70.0%), the median Ki67 was 52.7%, and the rates of positivity for HER2, EGFR, VEGFR, E-cadherin and PD-L1 were 40.0% (12/30), 46.7% (14/30), 80.0% (24/30), 86.7% (26/30) and 16.7% (5/30), respectively. At the cellular level, cancer cells were mainly distributed in small focal areas, as cell masses, or as tumor thrombi; large numbers of widely distributed atypic cells were seldom observed. At the tissue level, cancer cells were located in the mucosal layer in seven patients (23.3%), in the submucosal layer in 18 (60.0%), and in the muscular layer in five (16.7%); no cancer cells were identified in the outer membrane. Five of the seven tumors were located in the lamina propria, two in the muscularis mucosae, and none in the mucosal epithelium. Conclusion: Patients with skip metastasis at the esophageal resection margin at radical gastrectomy have unfavorable tumor biology and a high proliferation index, are at a late pathological stage, and the residual cancer is mostly located in the submucosa.

Mechanism of gut-microbiota-liver axis in the pathogenesis of intestinal failure-associated liver disease / 中华胃肠外科杂志

Intestinal failure (IF) is defined as the critical reduction of functional intestines below the minimum needed to absorb nutrients and fluids, so that intravenous supplementation with parenteral nutrition (PN) is required to maintain health and/or growth. Although the benefits are evident, patients receiving PN can suffer from serious cholestasis due to lack of enteral feeding and small intestinal bacterial overgrowth (SIBO). One such complication that may arise is intestinal failure-associated liver disease (IFALD). Evidences from recent studies suggest that alterations in the intestinal microbiota, as well as intraluminal bile acid driven signaling, may play a critical role in both hepatic and intestinal injury. Since Marshall first proposed the concept of the gut-liver axis in 1998, the role of gut-liver axis disorders in the development of IFALD has received considerable attention. The conversation between gut and liver is the key to maintain liver metabolism and intestinal homeostasis, which influences each other and is reciprocal causation. However, as a "forgotten organ" , intestinal microbiota on the pathogenesis of IFALD has not been well reflected. As such, we propose, for the first time, the concept of gut-microbiota-liver axis to emphasize the importance of intestinal microbiota in the interaction of gut-liver axis. Analysis and research on gut-microbiota-liver axis will be of great significance for understanding the pathogenesis of IFALD and improving the prevention and treatment measures.

The prognostic significance of primary tumor volume by MRI in cT3 low rectal cancer / 中国实用外科杂志

OBJECTIVE: To evaluate the clinical significance of primary tumor volume(PTV) by preoperative highresolution MRI measurement in subgroup of cT3 low rectal cancer. METHODS: A total of 99 patients with low rectal cancer who confirmed by pathology and assessed at stage-cT3 by MRI,did not undergo neoadjuvant chemoradiotherapy(nCRT) treated in Department of Colorectal Surgery,Fujian Medical University Union Hospital from June 2010 to December 2012 were adopted in the study. The relations between PTV and the depths of tumor infiltration out of mesorectum were analyzed through Spearman correlation analysis. The receiver-operating characteristic(ROC) curve was used to analyze the PTV and 3-year disease-free survival. Cox proportional hazard model was performed for influence factors analysis. RESULTS: The depth of tumor infiltration mesorectum and the PTV were revealed significantly correlated(P 15 cm~3 or PTV≤14.8 cm~3/>14.8 cm~3. The difference between groups revealed significant in the 3-year disease-free survival rate,the local recurrence rate and the distant metastases rate.COX regression analysis was utilized for 3-year disease-free survival,and the multivariate analysis indicated that PTV was an independent impact factor(HR=0.180,95%CI 0.078-0.415,P<0.05). CONCLUSION: The primary tumor volume (PTV) by preoperative high-resolution MRI measurement might be used as a new prognostic parameter for cT3 low rectal cancer.

Analysis of Related Factors in Elderly Patients with Strangulated Small Bowel Obstruction / 中国医学科学院学报

Objective To investigate the surgery-related factors of strangulated small bowel obstruction in the elderly patients. Methods The clinical data of 261 elderly patients with acute small bowel obstruction treated between July 2010 and September 2016 were analyzed retrospectively. Differences of clinical data,laboratory Results ,and CT findings were compared between the elderly strangulation group(ESt group,n=139)and the elderly simple group (ESi group,n=122). The surgery-related factors of strangulated small bowel obstruction in the elderly were analyzed by univariate and multivariate Logistic regression analysis. Results The ESt group and the ESi group showed significant differences in factors including muscle guarding (χ=102.331,P=0.000),American Society of Anesthesiologists(ASA) score≥3 (χ=69.748,P=0.000),leukocyte count (t=7.453,P=0.000),C-reactive protein (t=2.128,P=0.034),segmental mesenteric fluid (χ=78.655,P=0.000),thick-walled small bowel (χ=100.806,P=0.000),intestinal wall of hyperattenuation (χ=69.068,P=0.000),ascites (χ=89.299,P=0.000),mesenteric fat stranding (χ=80.255,P=0.000),bird's beak sign (χ=84.451,P=0.000),and stranding sign (χ=98.635,P=0.000). Univariate regression analysis indicated the above 11 factors were the surgery-related factors in elderly patients with strangulated small bowel obstruction. Multivariate Logistic regression analysis showed that the surgery-related factors included segmental mesenteric fluid (OR=3.576,95%CI:1.043-12.261,P=0.043),ASA score≥3 (OR=3.463,95%CI:1.149-10.441,P=0.027),muscle guarding (OR=3.288,95%CI:1.010-10.707,P=0.048),thick-walled small bowel (OR=3.046,95%CI:1.074-8.638,P=0.036),and increased leukocyte count (OR=1.307,95%CI:1.170-1.458,P=0.000). Conclusion Muscle guarding,ASA score≥3,segmental mesenteric fluid,thick-walled small bowel,and increased leukocyte count are the surgery-related factors of strangulated small bowel obstruction in the elderly patients.

Meta analysis of postoperative complications between laparoscopic resection and traditional open resection of mid-low rectal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To conduct a meta-analysis of postoperative complications between laparoscopic resection (Group LR) and traditional open resection (Group OR) of mid-low rectal carcinoma.</p><p><b>METHODS</b>Meta analysis was performed by two reviewers, who independently selected and extracted data retrieved from literatures and papers published in China Knowledge Resource Integrated Database (CNKI), Wangfang Data, Foreign Medical Journal Service (FMJS), PubMed, EMBASE and The Cochrane before August 2012 on comparison between two groups. The statistical analysis for research of complex standard was conducted through Revman 5.0.</p><p><b>RESULTS</b>Thirteen clinical case-control studies with a total of 2733 cases were enrolled for analysis, including 1368 cases in Group LR and 1365 in Group OR. The result showed that, compared with Group OR, Group LR had lower overall rate of postoperative complication (OR=0.76, 95%CI:0.62-0.92, P<0.01), lower rate of postoperative intestinal obstruction (OR=0.53, 95%CI:0.35-0.80, P<0.01), lower rate of incision complications (OR=0.43, 95%CI:0.28-0.67, P<0.01), similar incidence of anastomotic bleeding and fistula, and similar incidence of bleeding in abdominal cavity and pelvic cavity (all P>0.05).</p><p><b>CONCLUSIONS</b>The overall rate of postoperative complications of laparoscopic resection for mid-low rectal carcinoma is obviously lower than that of open resection. Laparoscope can be applied safely in the resection of mid-low rectal carcinoma.</p>

Application and development of quantum dots in the imaging of lymph node metastasis / 中华胃肠外科杂志

Quantum dots(QDs) are semiconductor nanocrystals composed of element from the periodic groups of II(-IIIIII( or III(-IIIII(, which possess wide excitation spectra and narrow emission spectra. The maximum emission wavelength of QDs can be controlled in a relatively simple manner by variation of particle size and composition. QDs can be tuned at a variety of precise wavelengths from ultraviolet(UV) to near infrared(NIR). QDs can be conjugated to a wide range of biological targets, including monoclonal antibodies, proteins, polymers and nucleic acid probes. These characteristics make it not only for revealing interaction of nucleic acids, proteins and other biological macromolecules, by biological imaging but also for detection of lymph node metastasis through preoperative and introperative lymphatic imaging. Along with the continuously improvement of observation techniques and quantum dot structure optimization in recent years, the research on lymph node imaging is ongoing.

Efficacy and safety of sunitinib on patients with imatinib-resistant gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of sunitinib on the management of gastrointestinal stromal tumors (GIST) patients with imatinib resistance.</p><p><b>METHODS</b>Clinical data of 48 patients with imatinib-resistant GIST received sunitinib therapy from May 2008 to April 2012 in the Union Hospital of Fujian Medical University were analyzed retrospectively. Eighteen patients received 50 mg/d of sunitinib in a protocol of 4/2 (4 weeks on and 2 weeks off) [50 mg/d (4/2)], and 30 patients received a protocol of 37.5 mg of sunitinib continuous daily dose (37.5 mg/d CDD).</p><p><b>RESULTS</b>The median duration of sunitinib administration of all the 48 patients was 56 weeks, and the short-term efficacy was evaluated at 24 weeks after the initial treatment according to the Choi criteria. The response rate was 27.1% (13/48), including 1 case with complete response (CR), 12 cases with partial response (PR), and 21 cases with stationary disease (SD). The disease control rate was 70.8% (34/48). The mean follow-up time of 48 patients was 89 weeks. The median progression-free survival (PFS) and overall survival (OS) were 48 weeks and 92 weeks respectively. Stratified analyses indicated that the median PFS of patients previously treated by imatinib 400 mg/d and >400 mg/d were 53 weeks and 35 weeks respectively (P=0.018), and the median OS of these two groups were 157 weeks and 71 weeks respectively (P=0.003). Patients with exon 11 mutations had a significantly shorter OS compared with those with exon 9 mutations (71 weeks vs 157 weeks, P=0.008). Hand-foot syndrome was the most common adverse effect (25/48, 52.1%), followed by nausea (24/48, 50.0%), fatigue (23/48, 47.9%), neutropenia(21/48, 41.7%). The sub-group analysis of two protocols of sunitinib administration showed that the incidence of diarrhea and hand-foot syndrome were higher in 50 mg/d (4/2) group than those in 37.5 mg/d CDD group (P=0.027, P=0.048).</p><p><b>CONCLUSIONS</b>Sunitinib is effective for the patients with imatinib-resistant GIST. After 400 mg/d imatinib treatment failure, sunitinib should be prescribed instead of increased dosage of imatinib. Patients with KIT exon 9 mutations present better prognosis than those with KIT exon 11 mutations. The protocol of sunitinib 37.5 mg/d CDD possesses better safety.</p>

Dehydroandrographolide succinate inhibits oxidative stress in mice with lipopolysaccharide-induced acute lung injury by inactivating iNOS / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of dehydroandrographolide succinate (DAS) on oxidative stress and induced nitric oxide synthase (iNOS) expression in a mouse model of lipopolysaccharide (LPS)-induced acute lung injury.</p><p><b>METHODS</b>Thirty male BALB/C mice were randomly divided into control group, LPS+DAS group and LPS group (n=10). The levels of interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), malondialdehyde (MDA) and superoxide dismutase (SOD) in the bronchoalveolar lavage fluid (BALF) were measured. The wet-to-dry ratio (W/D) of the lung tissue was determined to evaluate lung edema. HE staining was used to observe the pathological changes and lung injury scores. The expressions of iNOS mRNA and protein in the lungs were analyzed using RT-PCR and Western blotting, respectively.</p><p><b>RESULTS</b>IL-1β, IL-6, TNF-α and MDA levels in the BALF, W/D, lung injury scores, and iNOS mRNA and protein expressions increased and SOD in the BALF decreased significantly after intratracheal LPS injection. Compared with those in LPS group, IL-1β, IL-6, TNF-α and MDA in BALF, W/D, lung injury scores and iNOS mRNA and protein expression were significantly reduced and SOD in the BALF significantly increased in LPS+DAS group.</p><p><b>CONCLUSIONS</b>Dehydroandrographolide succinate can alleviate oxidative stress in LPS-induced acute lung injury possibly by inactivating iNOS.</p>

Effect of astragali injection on epithelial sodium channel expression in mice with acute lung injury / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of astragali injection on the expression of epithelial sodium channel in mice with acute lung injury (ALI) and explore the possible mechanism.</p><p><b>METHODS</b>Thirty C57BL/6 mice were randomized into 3 equal groups, namely the control group, ALI model group, and astragali injection treatment group. Twelve hours after the treatments, The wet-dry ratio (W/D) of the lungs, inflammation cell percentages in the bronchoalveolar lavage fluid (BALF) and histopathological changes of the lung tissues were examined, and the expressions of α-ENaC, TNF-α, and IL-8 mRNA in the lung tissues were determined with quantitative RT-PCR.</p><p><b>RESULTS</b>The neutrophil percentage in the BALF increased significantly in ALI group as compared with that in the other two groups. Pathological examination revealed milder lung tissue inflammation, congestion and edema in astragalus injection treatment group than in the ALI model group. Compared with those in the control group, α-ENaC mRNA expression decreased significantly while TNF-α and IL-8 mRNAs increased markedly in ALI group. In astragalus injection treatment group, the expression level of α-ENaC mRNA was higher than that in ALI group, and TNF-α and IL-8 mRNA expression lower than those in ALI group but higher than those in the control group.</p><p><b>CONCLUSION</b>Astragalus injection can ameliorate ALI in mice by inhibiting the release of inflammatory factors and up-regulating ENaC mRNA expression to promote the clearance of pulmonary edema fluid.</p>

Assessment of lymph node metastasis in gastric cancer: status quo, recent advances and new perspectives / 中华胃肠外科杂志

The precondition of accurate gastric cancer surgery is precise assessment of lymph node metastasis. To date, no imaging modality achieves both high sensitivity and high specificity in detecting lymph node metastasis in gastric cancer. Intraoperative sentinel node tracing and biopsy are the most popular method to identify the localization of tumor cell, but is limited to early gastric cancer. Nano-composite materials, designed for tumor imaging and tracing, show us a newly emerging domain for tumor detection in gastric cancer. The function of these nano-composite materials to detect lymph node metastasis in gastric cancer relies on the effective backflow of lymph system. However, the lymph vessels can be obstructed by tumor cells in advanced gastric cancer, which may restrain the application of these nanoparticles. Therefore, more methods to detect lymph node metastasis in gastric cancer should be explored. This review summarizes the characteristic of the targeted nanosphere. Based on the reported studies, a novel idea is conceived that targeted multifunctional nanosphere may be a potential method to achieve precise assessment of lymph node metastasis in gastric cancer.

Short-term efficacy of laparoscopic-assisted right hemicolectomy with D3 lymph node dissection in colon cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and short-term efficacy of laparoscopic-assisted D3 lymph node dissection for right colon cancer with a medial-to-lateral approach.</p><p><b>METHODS</b>Clinical data of 61 patients with right colon cancer undergoing D3 lymph node dissection from March 2006 to June 2010 were analyzed retrospectively. Among them,29 underwent laparoscopic-assisted right hemicolectomy (LARH group) and 32 underwent open right hemicolectomy (ORH group). The number of lymph node harvest, operative details, and complication rate were compared between the two groups.</p><p><b>RESULTS</b>The mean number of lymph node harvest did not differ significantly between the two groups (16.9±3.8 vs. 15.4±3.6). As compared to ORH group, although the operative time was significantly longer [(214.4±37.9) min vs. (193.3±28.8) min] in LARH group, the mean blood loss [(83.4±38.0) ml vs. (192.7±43.6) ml], time to first flatus [(44.6±20.8) h vs. (70.4±80.0) h], time to resumption of soft diet[(32.5±10.6) h vs. (59.7±10.4) h], and postoperative hospital stay [(11.2±2.2) d vs. (13.8±2.8) d] were more favorable(all P<0.05). Complication rate was lower in LARH group(10.4% vs. 9.4%), however the difference was not statistically significant.</p><p><b>CONCLUSIONS</b>LARH with D3 lymph node dissection is oncologically comparable with ORH for right colon cancer. It is a safe and feasible procedure associated with rapid postoperative recovery.</p>

Association of microvessel density and blood vessel invasion with the prognosis in rectal carcinoma at stages I to II / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the possibility of microvessel density (MVD) and blood vessel invade (BVI) as the indexes in predicting prognosis of rectal carcinoma at stages I to II.</p><p><b>METHODS</b>Tumor tissues from 380 patients who underwent resection of stage I or II rectal cancer were analyzed for MVD and BVI by immunohistochemical S-P method with anti-CD105 and anti-CD 34 antibody. Binary and multivariable Cox regression was applied to indicate independent factors associated with overall survival.</p><p><b>RESULTS</b>CD105 was present in the neovascularity of the cancer tissue but not in the normal tissue, while CD34 was present in the tumor tissue and the normal tissue. BVI on CD34 staining was significantly higher than that on HE staining. Multivariable analysis revealed that TNM stage, CD34-BVI, histologic type, and CD105-MDV were independent risk factors to predict the possibility of poor prognosis of stage I or II rectal cancer. CD34-BVI or CD105-MVD positivity had a hazard ratio of 4.483 (95% confidence interval 2.861-7.026) for mortality.</p><p><b>CONCLUSION</b>The expressions of CD34-BVI and CD105-MVD are independent factors to predict the possibility of poor survival of stage I or II rectal carcinoma. Detection of CD105-MVD combined with CD34-BVI may help predict clinical outcome and design further individualized adjuvant treatment.</p>

Expression of mucosal addressin cell adhesion molecule-1 during small bowel graft rejection in rat / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of mucosal addressin cell adhesion molecule-1(MAdCAM-1) during small bowel graft rejection and the effects of MAdCAM-1 on the development of acute rejection.</p><p><b>METHODS</b>Rat heterotopic small bowel transplantation (SBT) was performed in F344/N rats with syngeneic and allogeneic (BN-F344/N) grafts. Bowel and gut-associated lymphoid tissue(GALT) samples were collected from small bowel transplants on postoperative day(POD) 1, 3, 5 and 7. Histopathology assessment of the grafts was conducted to identify the rejection. MAdCAM-1 was detected by immunohistochemistry and Western blot.</p><p><b>RESULTS</b>During acute rejection, MAdCAM-1 was highly-expressed on gut lamina propia and GALTs, particularly on vascular endothelial cells in the gut lamina propia. There were no change of MAdCAM-1 expression in syngeneic grafts from POD1 to POD7. In allogeneic grafts, MAdCAM-1 expression in mesenteric lymph nodes was down-regulated, while up-regulated on the vascular endothelial cells in the lamina propria during acute rejection.</p><p><b>CONCLUSION</b>Alteration of MAdCAM-1 expression may be associated with the development of SBT graft rejection.</p>

Prophylaxis and Treatment of Early Complications after Live Small Bowel Transplantation: 4 Cases Report / 中国康复理论与实践

@#ObjectiveTo summarize the means of prevention and treatment for early complications (in the first month) of partial live small bowel transplantation.MethodsThrombus of anastomosis blood vessel, bleeding, infection, rejection, dysfunction of transplantated bowel were the main complications in the first month after operation, which should be paied more attention to. ResultsFour patients suffered acute rejection, respiratory tract infection, dysfunction of transplantated bowel in first month after operation. After accurately treating, all the complications were cured. The function of transplantated bowels were well. ConclusionPreventing and treating early complications accurately after partial live small bowel transplantation is important.

Study on novel gene GDDR related to gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To confirm the GDDR cDNA property of novel down-regulated full-length gene in gastric cancer, structure of genomic GDDR DNA and its promotor region. To predict its transcription factors and transcription factor binding sites. To explore function of GDDR gene in vitro.</p><p><b>METHODS</b>GDDR mRNA was located by in situ mRNA hybridization of gastric mucous membranes, and was amplified in 13 human organs and tissues. The structure and location of GDDR on chromosome, property of protein encoded by full-length GDDR were investigated by Bio-message technique. Promotor region of GDDR was confirmed, and transcription factors or their binding sites were predicted in software Gene2promoter and Matinspector of Genomatix. Both of vector pcDNA3.1/Myc-His(-)A inserted by GDDR ORF and control vector pcDNA3.1/Myc-His(-)A were respectively transfected into gastric cell lines 7901 by lipofectamin. Growth curve, MTT test and a morphological analysis were respectively performed.</p><p><b>RESULTS</b>GDDR mRNA was located in gastric mucous epithelial cells, and only was expressed in gastric tissue. 7739 bp genomic GDDR DNA located on chromosome 2p13.3, 21701 bp away from CA11-one stomach-specific gene related to gastric cancer. 618 bp promotor region of GDDR located at position +96 bp,and -419 bp of transcription start site of GDDR. The structure of genomic DNA or cDNA between gene GDDR and CA11 was mostly similar. Sequences of their promotor region were different, transcription factors and their binding sites also varied between gene GDDR and CA11. GDDR encoded protein including a trans-membrane peptide homologed to CA11 that have been proven to encode secrete protein. GDDR was another new member of BRCHOS family just was found. Gastric cell lines 7901 transfected by GDDR showed a marked decrease in growth rate by growth curve and MTT test (72 h, 0.341 +/- 0.014 vs 0.488 +/- 0.015 A, P < 0.01).</p><p><b>CONCLUSIONS</b>Stamoch-specific, novel down-regulated gene GDDR in gastric cancer locates in gastric mucous epithelial cells can markedly inhibit growth of gastric cancer cell lines 7901, GDDR is another new member of BRICHOS family related to gastric cancer except CA11.</p>

Therapeutic effects of operation in tumor invades adjacent structures cancer of cardia and stomach fundus / 中华外科杂志

<p><b>OBJECTIVE</b>To study the best style of operation in the treatment of tumor invades adjacent structures (T(4)) cancer of the cardia and stomach fundus.</p><p><b>METHODS</b>Two hundred and one patients with T(4) cancer of the cardia and stomach fundus underwent operation. Of them, 31 were treated by laparotomy, and 170 by combined resection of the involved organs. The 3- and 5-year survival rates and the postoperative complication rate and mortality rate were analyzed in the patients who had under gone combined resection of the involved organs.</p><p><b>RESULTS</b>The median survival of the patients undergoing combined resection of the involved organs (29.3 months) was significantly longer than that of those receiving laparotomy (4.9 months). The 3- and 5-year survival rates of 170 patients who had under gone combined resection of the involved organs were 46.2% and 22.8%, respectively. The 3- and 5-year survival rates of patients undergoing total gastrectomy and proximal gastrectomy were 54.9% and 29.2% and 32.2% and 12.5%, respectively, and the difference was statistically significant (chi(2) = 7.589, P < 0.01;chi(2) = 5.792, P < 0.05).The postoperative mortality rate and complication rate were 4.1% and 24.1%, respectively.</p><p><b>CONCLUSIONS</b>The patients without liver metastasis, widespread nodal involvement, peritoneal dissemination and local focus allowed by an en bloc combined resection in T(4) cancer of cardia and stomach fundus should undergo gastrectomy with a combined resection of the involved organs. Total gastrectomy should be performed to improve the curative effect.</p>

Long-term therapeutic effects of total gastrectomy in cancer of the cardia and stomach fundus / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate total gastrectomy for the treatment of cancer of the cardia and stomach fundus.</p><p><b>METHODS</b>Five hundred and thirteen patients with cancer of the cardia and stomach fundus underwent radical resection. Of them, 326 were treated using total gastrectomy (group TG); and 187, using proximal gastrectomy (group PG). The 5-year and 10-year survival rates and the postoperative complication rate and mortality rate were followed up and compared in the two groups.</p><p><b>RESULTS</b>The 5-year and 10-year survival rates of group TG were 43.6% and 24.5%, of group PG were 33.9% and 14.1%, respectively, and the difference was statistically significant (chi(2) = 4.421, P < 0.05, chi(2) = 5.726, P < 0.05). The postoperative complication rate and mortality rate of group TG were 14.7% and 3.1%, of group PG were 10.2% and 2.1%, respectively, and the difference was not statistically significant (chi(2) = 1.796, P > 0.05, chi(2) = 0.082, P > 0.05).</p><p><b>CONCLUSIONS</b>To improve long-term therapeutic effects, total gastrectomy should be recommended for stage III patients with cancer of the cardia and stomach fundus when tumor size is bigger than 3.0 cm or lymph node metastasis occur. The postoperative complication rate and mortality rate should not be increased and the esophagitis of gastroesophageal reflux should be avoided in the patients treated using total gastrectomy.</p>