Effects of laparoscopic hyperthermic intraperitoneal perfusion chemotherapy combined with intraperitoneal and systemic chemotherapy treatment in patients with untreated gastric cancer with peritoneal metastasis / 中华胃肠外科杂志

Objective: To investigate the efficacy of laparoscopic hyperthermic intraperitoneal perfusion chemotherapy combined with intraperitoneal and systemic chemotherapy (HIPEC-IP-IV) in the treatment of peritoneal metastases from gastric cancer (GCPM). Methods: This was a descriptive case series study. Indications for HIPEC-IP-IV treatment include: (1) pathologically confirmed gastric or esophagogastric junction adenocarcinoma; (2) age 20-85 years; (3) peritoneal metastases as the sole form of Stage IV disease, confirmed by computed tomography, laparoscopic exploration, ascites or peritoneal lavage fluid cytology; and (4) Eastern Cooperative Oncology Group performance status 0-1. Contraindications include: (1) routine blood tests, liver and renal function, and electrocardiogram showing no contraindications to chemotherapy; (2) no serious cardiopulmonary dysfunction; and (3) no intestinal obstruction or peritoneal adhesions. According to the above criteria, data of patients with GCPM who had undergone laparoscopic exploration and HIPEC from June 2015 to March 2021 in the Peking University Cancer Hospital Gastrointestinal Center were analyzed, after excluding those who had received antitumor medical or surgical treatment. Two weeks after laparoscopic exploration and HIPEC, the patients received intraperitoneal and systemic chemotherapy. They were evaluated every two to four cycles. Surgery was considered if the treatment was effective, as shown by achieving stable disease or a partial or complete response and negative cytology. The primary outcomes were surgical conversion rate, R0 resection rate, and overall survival. Results: Sixty-nine previously untreated patients with GCPM had undergone HIPEC-IP-IV, including 43 men and 26 women; with a median age of 59 (24-83) years. The median PCI was 10 (1-39). Thirteen patients (18.8%) underwent surgery after HIPEC-IP-IV, R0 being achieved in nine of them (13.0%). The median overall survival (OS) was 16.1 months. The median OS of patients with massive or moderate ascites and little or no ascites were 6.6 and 17.9 months, respectively (P<0.001). The median OS of patients who had undergone R0 surgery, non-R0 surgery, and no surgery were 32.8, 8.0, and 14.9 months, respectively (P=0.007). Conclusions: HIPEC-IP-IV is a feasible treatment protocol for GCPM. Patients with massive or moderate ascites have a poor prognosis. Candidates for surgery should be selected carefully from those in whom treatment has been effective and R0 should be aimed for.

Exploration of encouragement for full-range patient engagement in a value-based healthcare perspective / 中华医院管理杂志

Value-based healthcare emphasizes the importance of taking patients′ needs and experiences into full consideration during the entire diagnosis and treatment process and providing patient-centered medical services, so as to improve population health and medical outcomes with manageable medical costs.From this perspective, it is particularly important to investigate how patients could take full advantage of their subjective value and central role to engage in healthcare-related activities. This article aims to summarize the concepts and specific pathways relevant to patient engagement in the entire healthcare process, and provide specific suggestions and recommendations on promoting participation in health self-monitoring, access to disease and consultation information, shared decision-making(SDM)between doctors and patients, patients for patient safety(PFPS), patient-reported outcomes(PROs), participation in self-management, and participation in patient organizations, etc. This article provided valuable reference and evidence on implementation of relevant medical practices and policies.

Out-of-hospital management strategies for gastric cancer patients during the COVID-19 outbreak / 中华消化外科杂志

Since the outbreak of Corona Virus Disease 2019 occurred in December 2019, the reduction of population mobility has curbed the spread of the epidemic to some extent but also prolonged the waiting time for the treatment of patients with gastric cancer. Based on fully understanding the different staging characteristics of gastric cancer, clinical departments should develop reasonable out-of-hospital management strategies. On one hand, reasonable communication channels should be established to allow patients to receive adequate guidance out of the hospital. On the other hand, shared decisions with patients should be made to adjust treatment strategies, and education on viral prevention should be implemented to minimize the impact of the epidemic on tumor treatment.

Diagnosis and surgical treatment of peritoneal metastasis of gastric cancer / 中国肿瘤临床

With the prevalence of diagnostic laparoscopy, the concept of conversion therapy in unresectable gastric cancer, as well as the technical application of port implantation and hyperthermic intraperitoneal chemotherapy, new progress has been made in the area of gastric cancer peritoneal metastasis. However, the prognosis for peritoneal metastasis of gastric cancer remains extremely poor, and surgical treatment still lacks high-level evidence. Surgeons should pay attention to standardized diagnosis and evaluation during medical practice, and should conduct multidisciplinary discussions on important issues, such as patient screening, surgical indications, and postoperative chemotherapy. The progress of drug therapy is still the key to improve the prognosis of gastric cancer peritoneal metastasis in the future.

Safety analysis of implanted peritoneal ports in gastric cancer with peritoneal metastasis / 中国肿瘤临床

Objective: Intraperitoneal chemotherapy is increasingly being used in the treatment of gastric cancer with peritoneal me-tastasis, because the drug can directly act on the metastatic nodules. Repeated treatment can be administered through implanted ports, provided the ports are appropriately managed. Our study aimed to investigate the safety of peritoneal port implantation in pa-tients with gastric cancer with peritoneal metastasis. Methods: We retrospectively reviewed the records of patients undergoing intra-peritoneal port implantation for the administration of chemotherapy between June 2015 and June 2018 to investigate the causes of complications and to discuss their management and prevention. Results: Fifty-five ports were implanted in 54 patients with median us-age time of 8.4 (0.8-32.0) months. Complications occurred at 13 port sites (23.6%), including obstruction (7.3%), severe pain (5.5%), in-fection (3.6%), reflux (3.6%), access difficulty (1.8%), and subcutaneous mass formation (1.8%). The median interval from the time of port implantation to the development of complications was 2.1 months. No factor contributing to the complications was identified (P>0.05). Conclusions: Peritoneal port implantation to systematic chemotherapy in patients with gastric cancer with peritoneal metastasis is safe and feasible if the ports can be carefully managed.

Application value of carbon nanoparticle labeled lymph node staining in radical resection of adenocarcinoma of esophagogastric junction with preoperative chemoradiotherapy / 中华消化外科杂志

Objective To explore the application value of carbon nanoparticle labeled lymph node staining in radical resection of adenocarcinoma of esophagogastric junction with preoperative chemoradiotherapy.Methods The retrospective cohort study was conducted.The clinicopathological data of 56 patients with adenocarcinoma of esophagogastric junction who underwent preoperative chemoradiotherapy in the Peking University Cancer Hospital from January 2014 to November 2017 were collected.There were 52 males and 4 females,aged from 22 to 76 years,with an average age of 62 years.Among 56 patients undergoing total gastrectomy and D2 lymphadenectomy,17 using carbon nanoparticle lymph node staining and 39 using traditional lymph node sorting were respectively allocated into observation group and control group.Observation indicators:(1) treatment situations;(2) detection of lymph nodes;(3) perioperative complications;(4) follow-up.Followup using outpatient examination and telephone interview was performed to detect tumor recurrence or metastasis up to May 2019.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was evaluated by the independent sample t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was evaluated by the Mann-Whitney U test.Count data were described as absolute numbers,and comparison between groups was analyzed using the chi-square test or Fisher exact propability.Comparison of ordinal data was analyzed using the nonparametric rank sum test.Results (1) Treatment situations:patients in both groups were successfully treated with concurrent chemoradiotherapy based on intensity modulated radiotherapy before operation.Radical gastrectomy with D2 lymphadenectomy was successfully performed after chemoradiotherapy,and Roux-en-Y esophagojejunostomy was used to reconstruct the digestive tract during operation.The operation time and volume of intraoperative blood loss were respectively (217± 58)minutes and (112±60)mL in the observation group,and (235±65) minutes and (119±77)mL in the control group,with no statistically significant difference between the two groups (t =1.017,0.341,P＞0.05).(2) Detection of lymph nodes:the average number of harvested lymph nodes,average number of radiation target lymph nodes,and average number of peritarget lymph nodes were respectively 32± 10,21±8,and 7±4 in the observation group,and 22±7,16±5,5±3 in the control group,with statistically significant differences between the two groups (t=4.138,2.881,2.401,P＜0.05).The median number of positive lymph nodes harvested,median number of positive radiation target lymph nodes,and median number of positive peritarget lymph nodes were respectively 0 (range,0-2),0 (range,0-2),and 0 (range,0-0) in the observation group,and 0 (range,0-7),0 (range,0-3),and 0 (range,0-1) in the control group,showing no statistically significant difference between the two groups (Z=1.305,1.101,0.660,P ＞ 0.05).(3) Perioperative complications:6 and 18 patients in the observation group and the control group had complications,respectively,with no statistically significant difference between the two groups (x2=0.570,P＞0.05).Patients with complications were improved after drug treatment and local treatment without second operation.No local or systemic adverse reactions caused by carbon nanoparticles was observed during and after operation in the observation group.(4) Follow-up:56 patients were followed up for 5-65 months,with a median follow-up time of 32 months.There were 14 and 6 patients in the observation group and the control group with tumor recurrence or metastasis,respectively,showing no significant difference between the two groups (x2 =0.002,P＞0.05).Conclusion Carbon nanoparticle labeled lymph node staining in radical resection of adenocarcinoma of esophagogastric junction with preoperative chemoradiotherapy can increase the number of harvested lymph nodes.

Current status of diagnosis and treatment of early gastric cancer in China--Data from China Gastrointestinal Cancer Surgery Union / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the current status of diagnosis and treatment of early gastric cancer in China, based on the nationwide survey by China Gastrointestinal Cancer Surgery Union.</p><p><b>METHODS</b>The union sent questionnaires on basic diagnosis and treatment data of gastric and colorectal cancer to all the centers of the union. Different centers collected and summarized their data by year and sent back the questionnaires to the e-mail of theunion(gi_union@foxmail.com) for summary.</p><p><b>RESULTS</b>From 2014 to 2016, the union collected 285 questionnaires from 85 centers all over China. In these 3 years, a total of 88 340 cases of gastric cancer were summarized and there were 17 187 cases of early gastric cancer (part of the data was not available in some centers). The proportion of early gastric cancer varied from 19.5%(5711/29290) in 2014 to 19.0%(6081/32050) in 2015 and 20.0%(5395/27000) in 2016. Significant difference was found among them (χ=9.553, P=0.008). Significant differences existed not only in the proportion of early gastric cancer between the south (20.9%, 7618/ 36518) and the north (18.5%, 9569/51822) of China (χ=78.468, P=0.000), but also between the general (20.4%, 11991/58672) and the specialized (17.5%, 5196/29668) hospitals(χ=107.473, P=0.000). Ultrasonic endoscope was used as routine practice in 10(17.5%, 10/57) general hospitals and 9(56.2%,9/16) specialized hospitals, and significant difference was found between them (χ=9.721, P=0.002). A total of 4555 early gastric cancer patients received endoscopic therapy. The proportion of patients receiving endoscopic therapy was significantly different between the hospitals in the first-tier cities (36.0%, 2243/6233) and the other cities (21.1%, 2312/10954) (χ=451.526, P=0.000), and between the hospitals with more than 800 gastric cancer patients per year (28.9%, 3434/11884) and those with less than 800 gastric cancer patients (21.1%, 1121/5303)(χ=113.270, P=0.000). 37.1%(5270/14186) of early gastric cancer patients received laparoscopic surgery. The proportion of patients receiving laparoscopic surgery was 39.4%(3807/9651) in general hospitals and 32.3%(1463/4535) in specialized hospitals, whose difference was significant (χ=68.244, P=0.000). The proportion of patients receiving laparoscopic surgery was 29.3%(1269/4328) in the first-tier cities and 40.6%(4001/9858) in the other cities, whose difference was significant as well(χ=163.480, P=0.000). The proportion of patients receiving laparoscopic surgery was significantly different between the hospitals with more than 800 gastric cancer patients per year(34.5%, 3425/9929) and those with less than 800 gastric cancer patients (43.3%, 1845/4257) (χ=100.057, P=0.000), and between the hospitals in the south (42.4%, 2552/6016) and those in the north (33.3%, 2718/8170) of China (χ=124.296, P=0.000). 48.5%(6975) of early gastric cancer patients staged pT1a and 51.5%(7402) staged pT1b. Lymph node metastasis was found in 12.7%(1825/14377) of early gastric cancer. The lymph node metastasis rate of pT1a and pT1b was 5.7%(399/6975) and 19.3%(1426/7402), respectively. The lymph node metastasis rate of early gastric cancer varied from 12.7%(510/4017) in 2014 to 12.2%(668/5494) in 2015 and 13.3%(647/4866) in 2016.</p><p><b>CONCLUSION</b>The data report of China Gastrointestinal Cancer Surgery Union partly reflects the epidemiologic characteristics, current status of diagnosis and treatment of early gastric in China.</p>

Impact of neoadjuvant therapy on the number of harvested lymph nodes in D2 radical resection of the proximal locally advanced gastric cancer / 中华消化外科杂志

Objective To explore the impact of neoadjuvant therapy on the number of harvested lymph nodes in D2 radical resection of the proximal locally advanced gastric cancer (GC).Methods The retrospective cohort study was conducted.The clinicopathological data of 319 patients with proximal locally advanced GC who were admitted to the Beijing Cancer Hospital from January 2013 to September 2016 were collected.Of 319 patients,200 underwent D2 radical resection of GC and didn't undergo neoadjuvant therapy who were divided into the surgery group,88 underwent neoadjuvant chemotherapy into the chemotherapy group,and 31 underwent neoadjuvant chemoradiotherapy into the chemoradiotherapy group.Observation indicators and evaluation criteria:comparison of postoperative pathological results among 3 groups,according to tumor staging guideline of American Joint Committee on Cancer (AJCC) (8th version) Measurement data with normal distribution were represented as x±s,comparisons among groups were analyzed using the ANOVA.Measurement data with skewed distribution were described as M (range),comparisons among groups were analyzed using the ANOVA,and pairwise comparisons were analyzed using nonparametric test.Comparisons of count data among groups were analyzed using the exact chisquare test,and pairwise comparisons were analyzed using the chi-square partition method.Results Comparison of postoperative pathological results among 3 groups:stage T0,Tla,Tlb,T2,T3,T4a and T4b of T staging were respectively detected in 0,2,10,24,99,58,7 patients in the surgery group and 5,1,2,11,41,26,2 patients in the chemotherapy group and 5,1,2,8,10,4,1 patients in the chemoradiotherapy group.Stage N0,N1,N2,N3a and N3b of N staging 56,41,34,47,22 patients in the surgery group and 29,17,27,10,5 patients in the chemotherapy group and 18,10,2,1,0 in the chemoradiotherapy group.Cases with and without lymphovascular invasion were respectively 124,76 in the surgery group and 43,45 in the chemotherapy group and 6,25 in the chemoradiotherapy group.Total number of harvested lymph nodes,number of lymph node metastases and rate of lymph node metastasis in the surgery,chemotherapy and chemoradiotherapy groups were respectively 31 (range,15-87),30 (range,15-62),21 (range,15-36) and 3 (range,0-39),2 (range,0-37),0 (range,0-7) and 9.2％ (range,0-91.3％),7.7％ (range,0-78.7％),0 (range,0-30.4％).There were statistically significant differences in the T staging,N staging,with and without lymphovascular invasion,total number of harvested lymph nodes,number of lymph node metastases and rate of lymph node metastasis among groups (x2 =35.799,32.489,21.076,Z =27.120,22.088,16.947,P ＜ 0.05).There were statistically significant differences in the above indicators between surgery group and chemoradiotherapy group (x2 =28.500,20.124,19.570,P＜0.05),and no statistically significant difference in the above indicators between surgery group and chemotherapy group (x2 =11.436,12.343,4.295,P＞ 0.05).There were statistically significant differences in the N staging,with and without lymphovascular invasion,total number of harvested lymph nodes,number of lymph node metastases and rate of lymph node metastasis between chemotherapy group and chemoradiotherapy group (x2 =14.027,8.313,P＜ 0.05),and no statistically significant difference in the T staging between chemotherapy group and chemoradiotherapy group (x2=11.742,P＞ 0.05).Conclusion Neoadjuvant chemoradiotherapy could reduce the total number of harvested lymph nodes and number of lymph node metastases after radical resection of proximal locally advanced GC.

Comparison of the safety and the costs between laparoscopic assisted or totally laparoscopic uncut Roux-en-Y and BillrothII(+Braun reconstruction--a single center prospective cohort study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the short-term safety and costs between laparoscopic assisted or totally laparoscopic uncut Roux-en-Y and Billroth II((BII() + Braun reconstruction after radical gastrectomy of distal gastric cancer.</p><p><b>METHODS</b>Clinical data from our prospective database of radical gastrectomy were systematically analyzed. The patients who underwent laparoscopic gastrectomy with uncut Roux-en-Y or BII(+ Braun reconstruction between March 1st, 2015 and June 30th, 2017 were screened out for further analysis. Both the reconstructions were completed by linear staplers. Uncut Roux-en-Y reconstruction was performed with a 45 mm no-knife linear stapler (ATS45NK) on the afferent loop below the gastrojejunostomy. Continuous variables were compared using independent samples t test or Mann-Whitney U. The frequencies of categorical variables were compared using Chi-squared or Fisher exact test.</p><p><b>RESULTS</b>Eighty-one patients were in uncut Roux-en-Y group and 58 patients were in BII(+Braun group. There were no significant differences between uncut Roux-en-Y group and BII(+Braun group in median age (56.0 years vs. 56.5 years, P=0.757), gender (male/female, 52/29 vs. 46/12, P=0.054), history of abdominal surgery (yes/no, 10/71 vs. 4/54, P=0.293), neoadjuvant chemotherapy (yes/no, 21/60 vs. 11/47, P=0.336), BMI (thin/normal/overweight/obesity, 2/49/26/3 vs. 3/39/14/2, P=0.591), NRS 2002 score (1/2/3/4, 58/15/5/3 vs. 47/5/3/3, P=0.403), pathological stage (0/I(/II(/III(, 3/41/20/17 vs. 1/28/13/16, P=0.755), median tumor diameter in long axis (2.5 cm vs. 3.0 cm, P=0.278), median tumor diameter in short axis (2.0 cm vs. 2.0 cm, P=0.126) and some other clinical and pathological characteristics. There were no significant differences between uncut Roux-en-Y group and BII(+Braun group in morbidity of postoperative complication more severe than grade I([12.3% (10/81) vs. 17.2% (10/58), P=0.417], morbidity of anastomotic complication [1.2%(1/81) vs. 0, P=1.000] or hospitalization costs [(94000±14000) yuan vs.(95000±16000) yuan, P=0.895]. The median first time to liquid diet (57.1 hours vs. 70.8 hours, P=0.017) and median postoperative hospital stay (9 days vs. 11 days, P=0.003) of the patients in uncut Roux-en-Y group were shorter than those in BII(+Braun group.</p><p><b>CONCLUSION</b>Laparoscopic assisted or totally laparoscopic uncut Roux-en-Y reconstruction after radical gastrectomy of distal gastric cancer is safe and feasible with better recovery than BII(+Braun reconstruction.</p>

A surgery-oriented classification in conversion therapy of gastric cancer / 中华胃肠外科杂志

Clinical practice showed that some advanced gastric cancer (AGC) patients achieved long-term survival after surgery, whereas some benefited from non-surgical treatment. In recent years, with the emergence of new drugs, diversity of treatment and development of multi-disciplinary team, the concept of conversion therapy comes into attention. Owing to diverse phenotypes with scattered cases, publications are mainly case reports or small sample studies from single centers, which makes it hard to acquire high-level evidence. On illustrating the definitions of AGC and conversion therapy, as well as integrating peritoneal metastasis, liver metastasis, No.16 lymph nodes metastasis, cytology positive and organs infiltration (T4b), we tried to classify AGC as resectable IIII( and unresectable IIII(. Resectable IIII( refers to lesions that could be resected as R0 evaluated by present diagnostic modalities, conditions of patients and therapeutic management, in which it is further classified as low-risk and high-risk subtypes, according to operation risk. If R0 is not achieved with the evaluation as above, it is classified as unresectable IIII(, in which it is further classified as conversed, partly conversed and non-conversed types after systemic therapy. For AGC patients with unresectable IIII(, operation must be performed more carefully, and the making of treatment protocols, the judge of operational time and the choice of operation procedure should be based on multi-disciplinary team. Such classification is aimed to facilitate clinical application and launch clinical trials, better to explore the characteristics of AGC.

Clinical efficacy of laparoscopic vagus nerve and pylorus-preserving gastrectomy for early gastric cancer / 中华消化外科杂志

Objective To investigate the clinical efficacy of laparoscopic vagus nerve and pylorus-preserring gastrectomy (LVNPPG) for early gastric cancer.Methods The retrospective descriptive study was conducted.The clinical data of 5 patients who underwent LVNPPG for early gastric cancer at the Peking University Cancer Hospital between May 2016 and September 2016 were collected.Patients underwent laparoscope-assisted or total laparoscopic vagus nerve (hepatic branch and celiac branch) and pylorus-preserving gastrectomy.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) postoperative pathological examination;(4) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor metastasis and recurrence up to December 2016.Measurement data with normal distribution was represented as average (range).Results (1) Surgical situations:of 5 patients undergoing successful LVNPPG,digestive tract reconstruction using auxiliary incision was conducted in 3 patients and total laparoscopic surgery in 2 patients.Three patients received appliance side-to-side anastomosis and 2 received manual end-to-end anastomosis.Hepatic branch and celiac branch of vagus nerve in 5 patients were preserved.Average operation time and volume of intraoperative blood loss were 220 minutes (range,180-305 minutes) and 108 mL (range,30-216 mL).(2) Postoperative situations:average time to initial bowel exsufflation,average times for fluid diet intake and for semifluid diet intake were 3 days (range,2-4 days),3 days (range,1-5 days)and 10 days (range,5-25 days),respectively.One patient complicated with delayed gastric emptying was improved by conservative treatment.Duration of hospital stay of 5 patients was 13 days (range,7-32 days).(3)Postoperative pathological examination:number of lymph node dissected,average lengths of proximal margin and distal margin were 22 (range,15-35),3.5 cm (range,2.2-5.0 cm) and 3.7 cm (range,2.0-5.5 cm),respectively.Pathological T stage:pT0 stage was detected in 1 patient,pT1a stage in 1 patient,pT1b stage in 2 patients and pT2 stage in 1 patient.Pathological N stage:pN0 stage was detected in 3 patients and pN2 in 2 patients.Pathological TNM stage:0 stage was detected in 1 patient,Ⅰ a stage in 2 patients,Ⅱ a stage in 1 patient and Ⅱb stage in 1 patient.Two patients had stage migration,including from cT1N0 to pT2N2 and from cT0N0 to pTlbN2.(4) Follow-up situations:5 patients were followed up for 2.8-7.0 months,with a median time of 5.6 months.During follow-up,there were no death and occurrence of tumor metastasis and recurrence.Conclusion LVNPPG is safe and feasible for early gastric cancer.

Meta-analysis of the safety of Yangzhengxiaoji capsule for the treatment of cancer and precancerosis / 中国肿瘤临床

Objective:To evaluate the safety of Yangzhengxiaoji capsules for the treatment of cancer and precancerosis. Methods:Clinical trials and studies were collected by searching Chinese and English databases, including CNKI, WANFANG database, VIP information database, Pubmed, ScinenceDirect Online, and MEDLINE@EBSCO. The clinical data of Yangzhengxiaoji capsule for the treatment of cancer and pre-cancerosis were included. The quality of the included studies was then evaluated. Related data were extracted with reference to Cochrane Handbook 5.0. Afterward, meta-analysis was conducted using Revman 5.0 software. Results:A total of 19 studies focusing on 2 125 patients receiving Yangzhengxiaoji capsules were included and investigated in this meta-analysis. Results showed that the adverse reaction rates of myelosuppression, WBC and platelet decrease, gastrointestinal reaction, nausea/vomiting, and hepatotoxicity were sig-nificantly lower in the trial groups with Yangzhengxiaoji capsule-assisted chemotherapy/radiotherapy than in the control groups with chemotherapy/radiotherapy only (P0.05). Conclusion:Yangzhengxiaoji capsule could be safely administered to treat cancer and precancerosis.