[Prognostic analysis of 280 patients with T4a gastric cancer who underwent curative resection].

OBJECTIVE: To evaluate the predicators of survival and recurrence after curative resection for gastric cancer patients with serosal invasion. METHODS: Clinical and follow-up data of 280 patients with T4a gastric cancer(according to the 7th UICC TNM Classification for gastric cancer) who underwent curative resection for gastric cancer between January 1997 and December 2003 were analyzed retrospectively. RESULTS: Five-year survival rate of these 280 patients was 50.0% and 158 patients (56.4%) presented with recurrence after surgery. The 3-year disease-free survival rate was 57.5%. The number of lymph node metastasis and metastatic lymph node ratio(MLR) were identified as the independent predicators for overall survival(P<0.05). The extent of lymph node metastasis was identified as the independent predicators for disease free survival (P<0.05). The extent of lymph node metastasis, the number of lymph node metastasis, and MLR were identified as the independent predicators for recurrence after surgery(P<0.05). CONCLUSIONS: The number of lymph node metastases, extent of lymph node metastasis and MLR are independent predictors of overall survival and recurrence in T4a gastric cancer patients after curative resection.

Prognostic factors of young patients with colon cancer after surgery.

AIM: To investigate the prognostic factors of 96 young patients with colon cancer within a cancer center by univariate and multivariate analysis. METHODS: A total of 723 patients with colon cancer were treated surgically during a period of 10 years. Ninety six of them were 40 years old or younger.R0, R1 and R2 operations were performed in 69 (71.9%), 4(4.1%) and 23 patients(24%), respectively. Left hemicolectomy was performed in 43 patients, right hemicolectomy in 37 patients, transverse colon resection in 9 patients and low anterior resection in 7 patients. Cox multivariate regression analysis was performed to identify predictors of survival. RESULTS: The operation mortality was 0%, 54 patients died within 111 mo after operation due to occurrence or metastases of the tumor. Liver,lung and bone metastases occurred in 3, 1 and 5 patients, respectively. The mean survival time for all patients was 77.9 +/- 5.01 mo and the overall 3-,5- and 10- year survival rates were 66.68%, 58.14% and 46.54%, respectively. In the univariate survival analysis,patient age,type of operation, radical resection, blood transfusion, histological type, diameter of tumor,depth of tumor invasion, lymphatic invasion, distant metastases, liver metastases and TNM stage were found to be predictors of survival in young patients with colon cancer. In the Cox-regression analysis,blood transfusion and lymphatic invasion were determined as independent prognostic factors of survival. CONCLUSIONS: Age, type of operation, radical resection, blood transfusion, histological type, diameter of tumor,depth of tumor invasion, lymphatic invasion, distant metastasis and TNM stage are the predictors of survival in young patients with colon cancer after surgery.

[Determinants of long-term survival in 38 patients with carcinoma of ampulla of Vater treated by local resection].

OBJECTIVE: To investigate determinants of long-term survival for carcinoma of ampulla of Vater treated by local resection. METHODS: The clinical and pathological data of 38 such patients treated by local resection from 1983 to 2003 were retrospectively analyzed. According to UICC staging system, there were T1 30, T2 7 and T3 1. Lymph nodes were involved in 4 during operation which was present in primary lesions larger than 2 cm across. All patients were treated by local resection. At first, external palpation was carried out to ascertain accessibility. Then with the duodenum opened, direct exploration was carried out. On deciding for resection, the common bile duct was probe explored which guided the circumferential ring resection 1 cm, away from the tumor, including all layers of duodenum, ampula and partial bile and terminal pancreatic ducts and the posterial wall of duodenum was completed in steps. Meticulous care was taken not to suture the pancreatic duct and endotheliation was ensured at the mouth of common bile duct and duodenum. The basal tissue was frozen sectioned to ensure negative stumps. The gall bladder of 6 patients was also resected. SPSS 10.0 software was used in data processing, log-rank test used in univariate analysis and Cox equation for multivariate analysis and Kaplan-Meirer method for the survival rates. RESULTS: Thirty-eight patients received local resection giving an operative mortality of 0% and morbidity of 13.2%. The 1-, 5- and 10-year survival rate was 83.5%, 51.4%, and 38.9%, respectively, with a median survival of 3.35 years. Up to now, 13 patients have survived for more than five years and 2 patients beyond ten years. The tumour size, tumour grading, lymph node status and UICC stage were significant prognostic factors in univariate analysis. However, only lymph node status was a statistically independent predictor of prognosis in multivariate analysis. CONCLUSION: Local excision is safe giving low morbidity and good survival in carefully selected cases. Preferably it is indicated only in high risk patients with a pT1 and well differentiated ampullary cancer smaller than 1 cm in diameter.

[Analysis of prognostic factors of rectal cancer in the elderly].

BACKGROUND & OBJECTIVE: The relation between patient age and outcomes from colorectal cancer surgery is complex. It is generally believed that age should not be a determinant in consideration of prognosis for colorectal cancer patient. But there were few studies on the prognostic factors of rectal cancer in the elderly. We therefore performed a retrospective analysis of clinicopathologic characteristics of rectal cancer in 343 old patients with rectal cancer by univariate and multivariate analysis. METHODS: A total of 343 patients (older than 60 years) with rectal cancer were treated surgically during a period of 10 years. R0, R1, and R2 operations were carried out in 261 patients (76.09%), 29 patients (8.45%), and 53 patients (15.45%), respectively. Low anterior resection was performed in 116 patients; 169 patients underwent Miles operation; 58 patients underwent the other operations. RESULTS: The operation mortality was 0.87%; 149 patients died of occurrence or metastases of the tumor within 108 months postoperatively. Liver, lung, and bone metastases were occurred in 17, 18, and 1 patients, respectively. The mean survival time for all patients was 72.12+/-2.60 months and the overall 3-, 5-, and 10-year survival rates were 69.62%, 55.73%, and 34.23%, respectively. Univariate analysis showed that the predictors of survival were type of operations, radical resection, histological type, diameter of the tumors, depth of tumor invasion, lymphatic invasion, distance metastases, liver and lung metastases. Multivariate analysis showed that only radical resection, lymphatic invasion, liver and lung metastases were independent factors. CONCLUSION: The follow prognostic factors can influence the survival of rectal cancer in the elderly: type of operations, nature of operation, histological type, diameter of the tumors, depth of tumor invasion, lymphatic invasion, distance metastases, liver and lung metastases. The independent factors were nature of operation, lymphatic invasion, liver and lung metastases.

[Multivariate Cox analysis on prognostic factors after surgery for rectal carcinoma].

OBJECTIVE: To analyze a large cohort of patients with rectal cancer within a cancer center to determine the prognostic factors by univariate and multivariate analyses. METHODS: A total of 952 patients with rectal cancer were treated surgically during a period of 10 years. R0, R1 and R2 operations were carried out in 741 patients (77.8%), 75 patients (7.9%) and 136 patients (14.3%), respectively. There were more Miles operation (53.5%) than lower abdominal resection (LAR, 33.7%). RESULTS: The operation mortality was 0.3%, 418 patients were dead within 108 months postoperatively due to recurrence or metastases to liver, lung and bone in 53, 39 and 12 patients. The overall mean survival time for all patients was 73.52 +/- 1.70 months and the overall 3-, 5-and 10-year survival rates were 67.6%, 55.4% and 38.2%. The overall 3-, 5- and 10-year survival rates for patients treated by radical operation were 81.4%, 70.3%, 48.8%, respectively. Kaplan-Meier estimate showed that patient gender, age, radicality of resection, histological type, liver and pulmonary metastasis and TNM stage were the predictors of survival. Multivariate analysis showed statistically significant correlation with radicality of operation, histological type, depth of tumor invasion, lymphatic invasion, TNM stage, liver and pulmonary metastasis. CONCLUSION: For survival, statistically significant differences among prognostic factors in relation to radicality of resection, lymphatic invasion, TNM stage, depth of tumor invasion, histological type, liver and pulmonary metastasis are found.

[Prospective randomized trial of prophylaxis of postoperative peritoneal carcinomatosis of advanced gastric cancer: intraperitoneal chemotherapy with mitomycin C bound to activated carbon particles].

OBJECTIVE: To evaluate the beneficial effect of intraperitoneally applied mitomycin bound to activated carbon particles (MMC-CH) in the prevention and treatment of intraabdominal recurrence after curative surgery for gastric cancer. METHODS: One hundred and twenty-four patients with radically resected gastric cancer infiltrating the serosal surface were randomly divided into group receiving 50 mg mitomycin bound to a solution of 375 mg carbon adsorbent intraperitoneally before closure of the abdominal wound (n = 62) and a control group (n = 62). The patients with MMC-CH and the control group were received systemic chemotherapy 3 months or 3 weeks after operation respectively. The postoperative recurrence-free survival was evaluated to analyze the benefits of this treatment. RESULTS: After observation for 8 months (range, 2 - 65). The 3-, 5-year postoperative recurrence-free survival rates were significantly higher in the MMC-CH group (70.16%, 44.51%) than in the control group (27.09%, 14.45%), P < 0.01. CONCLUSION: Adjuvant intraperitoneal chemotherapy of gastric cancer by mitomycin bound to activated carbon particles is effected by an increased postoperative recurrence-free survival rate.