[Surgical treatment for local recurrence of rectal carcinoma after operation].

OBJECTIVE: To evaluate the value of reoperation for local recurrence of rectal carcinoma. METHODS: The data of 62 cases with post-operative local recurrence of rectal carcinoma were analyzed retrospectively. RESULTS: All the 62 patients received reoperation. Thirty two of those patients were treated with radical resection (16 patients combined multiple organ resection), 6 palliative resection, 11 colostomy, and 13 laparatomy only. The 1-, 3- and 5-year survival rates in the patients accepted radical resection were 90.6%, 59.4% and 18.8% respectively. But in patients undergone palliative resection and combined therapy, survival time was 6-24 months with median survival time of 16 months. The patients, accepted laparatomy and intra-abdominal chemotherapy, all died within 2-14 months postoperatively. For patients with postoperative recurrence time >5 years, <2 years and 2-5 years, the reoperation resection rates were 100%(11/11), 62.9%(22/35), and 31.3%(5/16) respectively, and there were significant differences among 3 groups (P<0.01). The rate of reoperation resection of pure local recurrence was 80.0%(32/40). The rate of reoperation resection of local recurrence, associated with near organ invasion, was 27.3%(6/22). The difference was significant(P<0.01). The reoperation resection rate of first operation with Dixon or Miles was 61.9%(26/42) and 30.0%(6/20), and the difference was significant as well(P<0.05). CONCLUSIONS: The recurrence of rectal carcinoma still needs positive operation in order to prolong the survival time and improve the quality of life of the patient. First operative procedure, post-operative recurrence time and recurrence type are important factors of reoperative resection.

[Effect of angiogenesis inhibitor SU6668 on the growth and metastasis of gastric cancer in SCID mice].

OBJECTIVE: To study the effect of angiogenesis inhibitor SU6668 on the growth and metastasis of gastric cancer in SCID mice. METHODS: Metastatic model was established by orthotopic implantation of histologically intact human tumor tissue into the gastric wall of SCID mice. Forty-eight mice were randomly divided into four groups, and saline, 5-FU, SU6668, and 5-FU plus SU6668 were administered by i.p. every day for 6 weeks after tumor implantation. The mice were killed and tumor weight, tumor inhibition rate, intratumoral microvessel density(MVD), apoptotic index(AI) and metastasis inhibition were evaluated. RESULTS: Compared with the control, tumor growth was significantly inhibited in mice treated respectively with 5-FU, SU6668 and 5-FU plus SU6668 with inhibition rates of 47.5%, 64.1% and 69.2% respectively. Decreased MVD and increased AI were noted in the mice treated with SU6668 and 5-FU plus SU6668. The incidences of liver and peritoneal metastases was significantly inhibited and decreased to 62.5%, 69.9% in SU6668 group, and 74.9%, 90% in 5-FU plus SU6668 group. The growth and metastasis of human gastric cancer implanted in SCID mice were significantly inhibited in SU6668 group and combined group, especially in combined group. CONCLUSION: Angiogenesis inhibitor SU6668 has a strong inhibitory effect on tumor growth and metastasis of human gastric cancer transplanted in SCID mice, and has synergistic effect combined with cytotoxic agents.

[Expression of vascular endothelial growth factor C and survivin in gastric carcinoma and their clinical implications].

OBJECTIVE: To investigate the expression of vascular endothelial growth factor C (VEGF-C) and survivin protein in human gastric carcinoma,and to evaluate their clinical implications. METHODS: The expressions of VEGF-C and survivin protein in tumor tissues,matched para- tumor tissues from 97 cases with gastric cancer and normal tissues form 20 normal controls,were determined by immunohistochemistry. Their relationships with clinicopathological parameters were analyzed. RESULTS: The positive rate of VEGF-C and survivin protein in tumor tissues (66.0% and 57.2%) was significantly higher than those in matched para-tumor tissues normal tissues (P< 0.05). There were no significant differences in VEGF-C expression considering tumor size,localization,histological grade,venous invasion,and distant metastasis (P > 0.05), while its expression was correlated with serosal infiltration, lymphatic invasion, lymph node metastasis and TNM stage III-IV (P< 0.05). The survivin expression was significantly related with serosal infiltration,lymphatic invasion, regional lymph node metastasis,distant metastasis, and TNM stage III- IV (P< 0.05), but not with histological grade, localization,venous invasion,and tumor size (P > 0.05). The 1, 3 and 5-year survival rates of the patients with positive VEGF-C or survivin protein were significantly lower than those of the patients with negative VEGF-C or survivin (P< 0.05), respectively. In additional,the expression of VEGF-C was positively correlated with survivin expression in gastric carcinoma (P< 0.01). CONCLUSION: The expressions of VEGF-C and/or survivin may be indicators for poor prognosis of gastric carcinoma.

[Diagnosis and treatment of benign duodenal tumor].

OBJECTIVE: To investigate the diagnosis and treatment of benign duodenal tumor. METHODS: Clinical data of 14 patients with benign duodenal tumor confirmed pathologically or by operation from Oct.1988 to Oct.2001 were analyzed retrospectively. RESULTS: Of 14 patients, 5 had Brunner's grand adenoma, 4 mesenchymoma, 2 leiomyoma, 2 hemangioma, 1 lipoma. Upper abdominal discomfort (64% ), gastrointestinal bleeding(50% ) and abdominal pain(20% ) were common manifestations. All cases received gastroscopy and only one case was diagnosed. Five cases received duodenoscope and the diagnosis was confirmed in 4 cases. Nine cases received hypotonic duodenography and lesions were found in 8 cases. Digital subtraction angiography was performed in 3 cases and detected all lesions. Computed tomographic scan and B-ultrasound were performed in 2 cases and only one case was diagnosed. Eleven cases (79% ) got definite diagnosis before operation. Tumor resection was performed in all patients. Perioperative death occurred in one patient. No recurrence occurred in 13 cases after following up from 2 to 11 years. CONCLUSION: Upper abdominal discomfort and gastrointestinal bleeding are common features in patients with benign duodenal tumor. Duodenoscopy and hypotonic duodenography are good diagnostic approaches. Surgical tumor resection is the first choice of treatment.

Clinical significance of preoperative regional intra-arterial infusion chemotherapy for advanced gastric cancer.

AIM: Preoperative intra-arterial infusion chemotherapy could increase the radical resection rate of advanced gastric cancer, but its effect on the long-term survival has not been assessed. This study was designed to evaluate the clinical significance of preoperative intra-arterial infusion chemotherapy for advanced gastric cancer. METHODS: Clinicopathological data of 91 patients who underwent curative resection for advanced gastric cancer were collected. Among them, 37 patients undertaken preoperative intra-arterial infusion chemotherapy were used as the interventional chemotherapy group, and the remaining 54 patients as the control group. Eleven factors including clinicopathological variables, treatment procedures and molecular biological makers that might contribute to the long-term survival rate were analyzed using Cox multivariate regression analysis. RESULTS: The 5-year survival rate was 52.5% and 39.8%, respectively, for the interventional group and the control group (P<0.05). Cox multivariate regression analysis revealed that the TNM stage (P<0.001), preoperative intra-arterial infusion chemotherapy (P = 0.029) and growth pattern (P = 0.042) were the independent factors for the long-term survival of patients with advanced gastric cancer. CONCLUSION: Preoperative intra-arterial infusion chemotherapy plays an important role in improving the prognosis of advanced gastric cancer.

Detection of serum tumor markers in the diagnosis and treatment of patients with pancreatic cancer.

BACKGROUND: Although a variety of tumor markers are available for diagnosis of pancreatic cancer, their sensitivity and specificity have not yet been ideal. The aims of this study was to detect a panel of serum tumor markers and to evaluate their significance in the diagnosis and prognosis of pancreatic cancer patients. METHODS: Eight serum tumor markers including AFP, CEA, CA-50, CA72-4, CA-125, CA153, CA19-9 and CA242 were detected in 129 patients with pancreatic cancer by using chemiluminescence immunoassay, immunofluorescence assay and immunoradiometric assay, respectively. The levels of these markers were compared in 99 patients with non-pancreatic malignant tumor, 63 patients with other benign diseases, and 27 patients with pancreatic cancer after pancreatectomy. RESULTS: Among the 8 tumor markers, CA19-9, CA242, CA-50, and CA72-4 were more sensitive in the diagnosis of pancreatic cancer. Parallel combined testing could increase the diagnostic sensitivity to 89.2%, and serial combined examination could increase the diagnostic specificity to 92.3%. The serum tumor markers levels were decreased significantly after radical tumor resection. CONCLUSIONS: Serum CA19-9, CA242, CA-50, and CA72-4 are the preferred tumor markers to be used in the diagnosis and follow-up of operated cases of pancreatic cancer. Testing of a panel of multiple serum tumor markers may increase the sensitivity and specificity in the diagnosis of pancreatic cancer.

Clinical characteristics and management of patients with early acute severe pancreatitis: experience from a medical center in China.

AIM: To study clinical characteristics and management of patients with early severe acute pancreatitis (ESAP). METHODS: Data of 297 patients with severe acute pancreatitis (SAP) admitted to our hospital within 72 h after onset of symptoms from January 1991 to June 2003 were reviewed for the occurrence and development of early severe acute pancreatitis (ESAP). ESAP was defined as presence of organ dysfunction within 72 h after onset of symptoms. Sixty-nine patients had ESAP, 228 patients without organ dysfunction within 72 h after onset of symptoms had SAP. The clinical characteristics, incidence of organ dysfunction during hospitalization and prognosis between ESAP and SAP were compared. RESULTS: Impairment degree of pancreas (Balthazar CT class) in ESAP was more serious than that in SAP (5.31+/-0.68 vs 3.68+/-0.29, P<0.01). ESAP had a higher mortality than SAP (43.4% vs 2.6%, P<0.01), and a higher incidence of hypoxemia (85.5% vs 25%, P<0.01), pancreas infection (15.9% vs 7.5%, P<0.05), abdominal compartment syndrome (ACS) (78.3% vs 23.2%, P<0.01) and multiple organ dysfunction syndrome (MODS)(78.3% vs 10.1%, P<0.01). In multiple logistic regression analysis, the main predisposing factors to ESAP were higher APACHE II score, Balthazar CT class, MODS and hypoxemia. CONCLUSION: ESAP is characterised by MODS, severe pathological changes of pancreas, early hypoxemia and abdominal compartment syndrome. Given the poor prognosis of ESAP, these patients should be treated in specialized intensive care units with special measures such as close supervision, fluid resuscitation, improvement of hypoxemia, reduction of pancreatic secretion, elimination of inflammatory mediators, prevention and treatment of pancreatic infections.

[Biological behavior of cardial cancer and its effect on surgical management].

OBJECTIVE: To study the biological behavior of cardial cancer and its influence on surgical management. METHODS: Complete clinicopathologic data of 46 cases with cardial cancer undergoing radical gastrectomy was investigated retrospectively. The relationships between tumor Borrmann type, depth of invasion, growth pattern, lymph node metastasis and 5-year survival rate postoperative were analyzed. RESULTS: Of 46 cases, Borrmann type III, Type IV and Type II was 76% (35/46), 18% (8/46) and 6% (3/46) respectively; 5-year survival rate was 40% (14/35), 0 (0/8) and 100% (3/3) respectively. In respect of the depth of invasion, pT(2) was 31% (14/46) cases with 71% (10/14) lymph node metastasis; and 5-year survival rate was 64% (9/14). pT(3) was 15% (7/46) cases with 86% (6/7) lymph node metastasis; and 5-year survival rate was 57% (4/7). And pT(4) was 54% (25/46) cases with 92% (23/25) lymph node metastasis; and 5-year survival rate was 12% (3/25). The growth pattern in 87% (40/46) cases was infiltrative; and 5-year survival rate was 28% (11/40); the growth pattern in 13% (6/46) cases was expansive; and 5-year survival rate was 100% (6/6). CONCLUSION: D(2)(+) radical total gastrectomy should be performed on the developed cardial cancer, and if necessary, resection of body and tail of pancreas should be chosen.

Effect of preoperative regional artery chemotherapy on proliferation and apoptosis of gastric carcinoma cells.

AIM: To study the effects of preoperative regional artery chemotherapy (PRACT) in inducing growth inhibition and apoptosis of gastric carcinoma (GC) cells. METHODS: TUNEL (terminal-deoxynucleotidyl-transferase TdT-mediated dUTP-fluorescein and labeling) method and immunohistochemical techniques were used to detect the state of apoptosis and proliferation of GC cells in histopathologic sections. A total of 110 cases of GC and 68 cases of metastatic lymph node with or without PRACT were adopted. Correlations between apoptosis index (AI), proliferation index (PI) and PRACT and prognosis were analysed. RESULTS: The apoptosis index (AI) was significantly higher in the PRACT group (12.5 +/-4.33 ) than in the untreated group (7.1 +/-3.43 , P<0.001), whereas the proliferation index (PI) in the PRACT group (33.8%+/-8.8%) was significantly lower than that in untreated group (43.6%+/-12.8%, P<0.01). Both AI and PI were correlated to the differentiation degree of GC in PRACT group, the AI in the differentiated group was higher than that in undifferentiated group (P<0.001), but the PI was lower in the differentiated group than that of the undifferentiated group (P<0.01). The AI of GC cells in metastatic lymph node was also significantly higher in the PRACT group (7.9 +/-3.41 ) than in the untreated group (3.6 +/-2.93 , P<0.01), though the PI of GC cells in metastatic lymph nodes in the PRACT group (17.2%+/-6.8%) was significantly lower than that in the untreated group (26.7%+/-9.3%, P<0.01). The severity of histopathologic changes was significantly higher in the PRACT group than in the untreated group (P<0.05). In addition, postoperative surveys demonstrated that the 5-year survival rate of GC patients in the PRACT group was significantly higher than that of patients in the untreated group (P<0.01). CONCLUSION: Preoperative regional artery chemotherapy (PRACT) showed inhibitory action on the growth of GC cells mainly through inhibiting proliferation and inducing the apoptosis of tumor cells. PRACT can improve the progno sis of GC patients also.

Enteral nutrition in treatment of severe acute pancreatitis.

OBJECTIVE: To observe the role and the timing of EN in the treatment of patients with severe acute pancreatitis (SAP). METHODS: Eleven patients with severe acute pancreatitis underwent systemic nutrition support were studied. EN was given through jejunostomy tube (or Bengmark tube) after a period of PN maintenance. EN started when serum and urine amylase activity returned to normal with regular peristaltic sound, defecation or break wind. The sequence of preparation was as follows: saline glucose-->chemically defined diet-->polymeric diet-->normal diet. RESULTS: In all the patients, none died. The rate of late complications was lower, and the levels of serum albumin and transferritin significantly increased in the post-EN period as compared with the pre-EN period, although the count of lymphocytes was less changed. CONCLUSIONS: Nutritional support should be transformed from PN to EN as early as possible during the treatment of patients with severe acute pancreatitis. EN could not only continue sufficient nutritional support, but also avoid the unfavorable effects of long-time PN, thus reducing complications as well as mortality.