[Clinical analysis of 29 cases with neuroendocrine neoplasm in the digestive system].

OBJECTIVE: To investigate the diagnosis and treatment of neuroendocrine neoplasm (NEN) in the digestive system. METHODS: Clinical data of 29 patients with NEN from January 2000 to December 2012 in The First Affiliated Hospital of Dalian Medical University were analyzed retrospectively and the prognosis was evaluated according to the new WHO classification. RESULTS: There were 19 males and 10 females and the average age was 46.5 years. All the patients had no clinical manifestations of carcinoid syndrome, and they all received surgical treatment. Two cases were gastric neuroendocrine carcinoma(NEC), who received radical total gastrectomy and distal gastric resection respectively. Three cases had neoplasm in the duodenum, including 2 NEC and 1 neuroendocrine tumor(NET), and they all underwent Whipple's procedure. Two cases were small intestine NEC, who received partial small intestine resection. Three cases had neoplasm in the appendix, including 1 NEC treated with right hemicolectomy and 2 NET with appendectomy. One case was ascending colon NEC, who received right hemicolectomy. Eighteen cases had neoplasm in the rectum, including 4 NEC treated with low anterior resection and abdominoperineal resection respectively, and 14 cases of NET underwent low anterior resection, local resection, and endoscopic resection respectively. The 1- and 3- year survival rates of 13 NEC cases were 38.4% and 7.7% respectively. The 5-year survival rate of 16 NET cases was 81.3%. CONCLUSIONS: NEN of digestive system is located mainly in the rectum and the clinical symptom is unspecific. Radical resection of NEN is the preferred treatment. The prognosis of NEC is poor, and that of NET is better.

[Efficacy observation after pylorus-preserving gastrectomy for early gastric cancer].

OBJECTIVE: To evaluate the outcomes after pylorus-preserving gastrectomy (PPG) for early gastric cancer(EGC). METHODS: Clinicopathologic data of 52 patients with EGC undergoing PPG between August 1995 and December 2005 were analyzed retrospectively. A total of 159 patients of EGC who underwent distal gastrectomy with lymph node dissection(control group) were compared with those who received PPG. RESULTS: The lymph node metastasis rate of EGC was 9.6% in PPG group, including 9.6% in No.3, 3.9% in No.4, 3.9% in No.6, and 3.9% in No.7. In the control group, the lymph node metastasis rate was 17.0%, including N1(14.5%) and N2(2.5%). There were no significant differences between the PPG group and the control group (P>0.05). In the PPG group, D1 dissection was 25%, D1+α was 25%, D1+ß was 34.6%, and D2 was 15.3%. In control group, 121 patients(76.1%) had less than D2 dissection, while there were 33(20.7%) D2, and 5(3.1%) D3, and the difference was not statistically significant(P>0.05). There were no significant differences between the two groups in overall 5-year survival rate(92.3% vs. 93.1%, P=0.881). The 5-year survival rate in the PPG group was 100% for D1, 92.3% for D1+α, 88.9% for D1+ß, and 85.7% for D2, while the 5-year survival rate in the control group was 92.3% for D1, 93.3% for D1+α, 91.7% for D1+ß, and 93.9% for D2. The difference was not statistically significant(P>0.05). The recurrence rate was comparable (5.7% vs. 5.6%, P>0.05). CONCLUSION: Pylorus-preserving gastrectomy may provide long-term survival benefits for patients with early gastric cancer.

[Clinicopathological features and outcome of patients with remnant gastric cancer].

OBJECTIVE: To evaluate the clinicopathologic features and the efficacy of surgical treatment in gastric stump cancer. METHODS: Forty-two patients undergone operation for gastric stump cancer, including 9 cases with Billroth I (reconstruction and 33 cases with Billroth II reconstruction, in our department were enrolled in the study. Clinicopathological features, 5-year survival rate and prognostic factors were analyzed retrospectively. RESULTS: Gastric stump cancer occurred more frequently in anastomotic site and poorly-differentiated cancer was the common histological type. For patients with Billroth I reconstruction, the rates of lymph node metastasis in No.1, No.3, No.10, No.11 stations were more than 30.0%, and that in No.12 station was 22.2%. For patients with Billroth II reconstruction, the rates of lymph node metastasis in No.1, No.2, No.3, No.4, No.10, No.11, No.12 stations were more than 30.0%, and that in No.14 station was 25.0%. The rate of lymph node metastasis in jejunal mesentery was 27.3%. The percentage of pancreatic invasion and hepatoduodenal ligament invasion were 66.7% and 33.3% respectively for patients with Billroth I reconstruction. The percentage of transverse colon invasion and pancreatic invasion were 25.0% and 75.0% respectively for patients with Billroth II reconstruction. The overall 5-year survival rate of patients with gastric stump cancer was 0.38. The 5-year survival rates in I, II, III and IV were 0.86, 0.50, 0.13 and 0 respectively. There were significant differences among stages (P <0.05). CONCLUSIONS: Gastric stump cancer has a particular pattern in lymph node metastasis and direct organ invasion. Surgical resection is an effective therapeutic strategy for this disease.

Progression and prognosis of gastric stump cancer.

BACKGROUND AND OBJECTIVES: The incidence of gastric stump cancer (GSC) is increasing. The aim of this study is to determine the clinicopathologic feature and the differences of surgical outcome between GSC after partial gastrectomy for benign diseases (GSC-B) and GSC after partial gastrectomy for malignant tumors (GSC-M). METHODS: Medical records of 42 patients with GSC-B and 47 patients with GSC-M who underwent surgical treatment were studied and analyzed retrospectively. Clinicopathologic parameters, the 5-year survival rate after operation and prognostic factors, were analyzed retrospectively. RESULTS: GSC was frequently detected in anastomotic site. Poorly differentiated cancer was common. No difference was found between patients with GSC-B and patients with GSC-M in terms of histologic type, tumor location, and distribution of tumor stage. GSC-B patients had a higher incidence in No. 7, 8, 9 lymph nodes than GSC-M patients. In contrast, the patients with GSC-M had higher incidence of metastasis to jejunal mesentery lymph nodes and No. 10, 11 lymph nodes. The overall 5-year survival rates were 38.1% for GSC-B and 10.4% for GSC-M, with significant difference (P < 0.05). CONCLUSIONS: GSC has a particular pattern in lymph node metastasis and organs invasion. Surgical resection is considered an effective therapeutic strategy for GSC.

[Clinical study of lymph node dissection for early gastric cancer].

OBJECTIVE: To explore the pattern of lymph node metastasis and to determine a rational approach of surgery for early gastric cancer (EGC). METHODS: Between January 1994 and January 2008, 165 patients with EGC were given D2 or over dissection. Clinicopathologic data of this group was analyzed retrospectively. RESULTS: The lymph node metastasis rate was 3.8% in mucosa carcinoma (m-carcinoma), and was limited in first-tier; it was 25.7% in submucosa carcinoma (sm-carcinoma) and metastasized to second-tier and third-tier. Lymph node metastasis rate of EGC in u-region was low and was only limited in first-tier. But, in L-region, second- and third-tier lymph node metastasis was found in 5.2% and 0.9% of the patients, respectively. Second-tier lymph node metastasis was found in No. 7, 8, 9 and third-tier in No. 12, 14V, 16. The tumor size and lymph node metastasis was related closely, the lymph node metastasis only involved first-tier in m-carcinoma with a diameter < 5 cm, but the second-tier was involved in all sm-carcinoma. Significant difference was found in survival depending on the grade of tumor invasion: the cumulative 5-year survival rate was 97.3% in the m-carcinoma and was 87.6% in the sm-carcinoma (P = 0.019). There was no significant difference in survival between the extents in lymph node dissection (D2 93.8%, D3 91.7%) (P = 0.677). CONCLUSIONS: D2 and D2+ lymph node dissection is necessary for sm-early gastric cancer. A less radical approach could be applied to m-early gastric cancer in the u-region with a diameter < 2 cm.

[Investigate on rational lymph-node dissection for gastric cardia cancer].

OBJECTIVE: To investigate the rule of lymph-node metastasis in gastric cardia cancer and the rational extent of lymph node dissection. METHODS: Clinicopathological data of 77 patients with gastric cardia cancer were reviewed and the relationship between extent of lymph-node dissection and prognosis was analyzed retrospectively. RESULTS: (1) The lymph node metastasis rates were 64.9% for N(1), 14.3% for N(2) and 10.4% for N(3). (2) No lymph node metastasis was detected in T(1) stage tumor and maximum diameter of less than 2.0 cm. The lymph node metastasis rates were 20% for T(2), 68.2% for T(3) and 82.8% for T(4) respectively. (3) Lymph node No.1, 3, 2 were often involved in the metastasis of lymph node group 1, and No.7, 8, 10, 9 in Group 2. In lymph node group 3, lymph node metastasis rates were 6.5% for No.5, 1.3% for No.6, 1.3% for No.16 and 2.6% for No.107-110. (4) The five-year survival rates were 36.5% for D(3), 31.3% for D(2), and 22.7% for D(1) lymphadenectomy respectively. The survival rates of patients undergone D(2) and D(3) lymphadenectomy were significantly higher than that undergone D(1) dissection (P<0.05). CONCLUSION: D(2) or more than D(2) lymphadenectomy associated with enlargement of esophageal hiatus via laparotomy, lower partial esophagectomy and total gastrectomy is able to achieve surgical resectability and improve the survival rate of gastric cardia cancer patients.