Association of nutrition with treatment compliance and toxicities in patients undergoing chemoradiation after gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association of nutritional status with treatment compliance and toxicities in patients undergoing chemoradiation therapy (CRT) after gastrectomy.</p><p><b>METHODS</b>From September 2010 to May 2012, 40 patients with gastric cancer received adjuvant CRT in the Department of Radiation, Shanghai Cancer Center. Data including clinical data, weight loss of perioperative period, dynamic changes of weight, NRS 2002 score, PG-SGA score, lymph cell count and serum albumin during CRT, toxic effects and nutritional interventions were collected. Treatment compliance of CRT and adjuvant chemotherapy was recorded. Associations among nutrition, toxicities and treatment compliance were statistically studied.</p><p><b>RESULTS</b>Weight loss percentage from pre-operation to pre-CRT(T1-T2) was 10.0%, which was significantly higher than that of 4.3% during CRT(T3) (P<0.05). Adverse reaction incidence of digestive tract during T3 was 95.0% (38/40). Patients with weight loss >5% during T3 had higher ratio of >II degree digestive tract adverse reaction [91.3% (21/23) vs. 76.5% (13/17), P<0.01] and higher ratio of >3 symptoms of digestive tract[82.4% (14/17) vs. 39.1% (9/23), P<0.05] as compared to those with weight loss ≤5% during T3. Fourteen patients (35.0%) did not complete the synchronous CRT. Factors related to incompletion of CRT were weight loss >7% after surgery (T1) or >10% during T1-T2, malnourishment before CRT, dependence on nutritional support during CRT. Factors related to incompletion of adjuvant chemotherapy were weight loss >5% during CRT(T3), requirement for nutritional support and NRS 2002 score ≥5 at the end of radiation (all P<0.05).</p><p><b>CONCLUSIONS</b>Nutritional deterioration before CRT may aggravate the toxicities and reduce compliance of CRT in patients with radical resection of gastric cancer. Malnutrition during CRT may impair compliance to adjuvant chemotherapy. Therefore, early and persistent nutritional interventions are crucial considerations of strategies of multidisciplinary treatment for patients with gastric cancer.</p>

Clinical analysis of 168 cases of multiple primary colorectal carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To study the incidence rate of multiple primary colorectal carcinomas (MPCC) in colorectal carcinoma and to evaluate its clinical and pathological characteristics.</p><p><b>METHODS</b>One hundred and sixty-eight (4.6%) patients from 3663 cases with colorectal carcinoma were diagnosed with MPCC from January 1985 to December 2003. The clinical data of the patients were collected retrospectively to investigate the diagnosis and treatment of MPCC.</p><p><b>RESULTS</b>Of the 168 patients, 81 were diagnosed as synchronous colorectal carcinoma (SC), 72 with metachronous colorectal carcinoma (MC), 15 with both SC and MC. The median age at time of diagnosis of colorectal carcinoma was 58 years old (range from 20 to 82 years old). Three hundred and ninety-three cancer lesions were detected in these 168 cases (mean, 2.3 lesions/case). The rectum and sigmoid colon were the most involved sites (61.6%). Eighteen cases (10.7%) were verified with hereditary non-polyposis colorectal cancer (HNPCC) while another 9 cases were highly suspected. Fourteen patients (8.3%) were found with other malignancies out of large intestine, 41 patients (24.4%) with colorectal adenomas, 72 (42.9%) with adenoma carcinogenesis. Among the 96 SC patients, 91 were given preoperative colonoscopy and 65 (71.4%) got the diagnosis. All the MC patients were diagnosed by postoperative colonoscopy. The overall 5-year survival rate of the 168 patients was 69.8%.</p><p><b>CONCLUSIONS</b>MPCC should be paid more attention in colorectal cancer management. Colonoscopic surveillance is much more important in diagnosis and follow-up of MPCC for reducing the misdiagnosis of SC and detecting more MC in time. Prompt treatment of adenoma can reduce the occurrence of MPCC, and active and standard surgical treatment should be done for MPCC.</p>

Effect of high amounts of medium chain triglyceride and protein enteral nutrition on nutritional status in patients after major abdominal operation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Nutrition MCT and Nutrition MF enteral nutrition on nutritional status of patients after major abdominal operation.</p><p><b>METHODS</b>In a double- blinded and randomized cross- cover study, Nutrition MCT and Nutrition MF enteral nutrition were fed in patients when the gut function restored after operation. The total calorie was 104.6 kJ(25 kcal) x kg(-1) x d(-1) and the period of full dose of enteral nutrition was 5 days. The blood samples were collected before operation,before enteral nutrition and the sixth day after full dose of enteral nutrition for the measurement of pre- albumin, total protein,albumin, transferrin and triglyceride. The urine, stool and drainage fluid were collected to analyze nitrogen balance.</p><p><b>RESULTS</b>The plasma protein and fat were obviously dropped in patients after abdominal operation and improved after the enteral nutrition support in two groups. However, the pre- albumin level increased more in patients of Nutrition MCT than Nutrition MF.</p><p><b>CONCLUSION</b>Nutrition MCT can obviously improve the nutritional status of patients after major abdominal operation.</p>

Realization of clinical diagnoses and treatment for dermatofibrosarcoma protuberans / 中华外科杂志

<p><b>OBJECTIVE</b>To emphasize the importance of correct and standardized surgical treatment on dermatofibrosarcoma protuberans (DFSP), and discuss the suitable synthesized therapy on it.</p><p><b>METHODS</b>163 cases of DFSP, which were treated between January 1985 and September 2002,were submitted to a retrospective study.</p><p><b>RESULTS</b>Among the 163 cases, 150 (92.0%) were treated with local excision as benign tumors before accepted to Cancer Hospital, Fudan University. 69 cases (46.0%) were approved by pathological examination to have tumor remnants after they were treated with wide excision, and 49 (71.0%) of them couldn't be found to have any tumor remnants by physical examination or B-ultrasonic examination before that operation. It was easy for the tumor to recur after excision, especially the local excision. The recurrent rate after it was 45.1%, which was much higher than the one after wide excision (5.6%). Among the 142 cases which wide excision were performed, 99 ones had excision margins >/= 3 cm and 5 of them (5.1%) developed local recurrence while 36 ones had excision margins 1 approximately 2 cm and 3 of them (8.3%) developed local failure. 46 cases (32.4%) were given skin graft, 11 cases were given flap, and 1 case had dacron mending in skin defection area. The main complications after these operations were necrosis of the skin flap (20 cases) and infection of the wound (6 cases). They could all be cured in 2 months. 17 cases were given complimentary radiotherapy with the dose range from 3275 cGy to 7000 cGy because of their recurrences for times or positive resection margins after wide excision. Only one case had wet molting after radiotherapy and 2 developed local recurrence. Among all the 163 cases, only 2 (1.2%) were dead, and 1 of them was died of metastasis of lung and liver. 2 cases got lymph node metastasis, then were given surgical treatment and still alive now. 13 cases (8.0%) were DFSP-FS with their malignancies increased. 11 of them were the recurrent ones after local excision or wide excision.</p><p><b>CONCLUSIONS</b>In order to avoid misdiagnosis, it is necessary for the clinician to know much about DFSP. Once the tumor was diagnosed of DFSP after local excision, it is necessary to take wide excision. Because DFSP is a malignancy of a high recurrent rate after local excision, standardized wide excision is the key in reducing local failure. Adjuvant radiotherapy is an effective treatment for the patients with positive resection margin or the patients don't suit for surgical treatment. The DFSP-FS need to use more energetic treatment in curing it.</p>

Discussion for clinical treatment in early stage of colorectal carcinoma with the invasion limited in the layer of muscularis mucosae / 中华外科杂志

<p><b>OBJECTIVE</b>To emphasis the importance of recognizing and treating the early colorectal carcinoma with the invasion limited in the layer of muscularis mucosae, and discuss several questions in using the WHO's new diagnostic standards of the prestage of tumors of digestive system.</p><p><b>METHODS</b>A retrospective review was made of 30 patients with invasive carcinoma limited in the layer of muscularis mucosae. All of the patients were treated between July 1986 and July 1999 in Shanghai Cancer Hospital.</p><p><b>RESULTS</b>Among the 30 cases, there were 19 men and 11 women from 20 to 80 years dd (mean, 57.0). The tumor diameter was ranged from 0.8 cm to 8.0 cm (mean, 2.9 cm). 12 patients were given polypectomy while 18 patients were given radical resection. Among the patients given polypectomy, one got recurrence 3 years later, one had the metastasis of lungs 50 months later and had been dead already. Among the patients given radical resection, one had metastasis of lymph nodes peripheral to the tumor, one also had the metastasis of lungs 68 months later but is still alive now, and one had metastasis of lymph nodes in the right upper part of neck 15 months later and then was lost to follow-up.</p><p><b>CONCLUSIONS</b>The patients with early colorectal carcinoma with the invasion limited in the layer of muscularis mucosae could have metastasis of lymph nodes, get local recurrence after polypectomy and even have blood metastasis. Therefore great attention must be paid. Clinicians should be careful to chosen polypectomy. Meanwhile, in order to provide more information of the correct treatment, it will be better if the pathologists could give the original diagnosis at the same time when they use the WHO's new diagnostic standards of the prestage of tumors of digestive system in diagnosing the early invasive carcinoma limited in the layer of muscularis mucosae, for the concept of high-grade intraepithelial neoplasia will be used instead of it, and whether or not it is a really benign tumor, much more clinical research must be done later.</p>