Pancreatic acinar cell carcinoma-case report and literature review.

BACKGROUND: Pancreatic acinar cell carcinoma (ACC) is a rare tumor that constitutes 1% of all pancreatic neoplasms. Pancreatic ACC has unique characteristics in terms of biological behavior, imaging and prognosis. CASE PRESENTATION: The present study reported two cases of pancreatic ACC confirmed by postoperative pathology and both cases exhibited several different imaging features and laboratory test results. Both cases had approximately 4 cm mass located in uncinate process of pancreas. Dilated intra- and extra-hepatic bile ducts was observed in one case, along with calcification. Heterogeneous enhancement of the tumor was exhibited in both patients with different intensities. Obstructive jaundice, elevated α-fetoprotein and CA 19-9 was found in one case, while the other case had normal liver function and tumor markers. CONCLUSIONS: It was difficult to accurately diagnose pancreatic ACC before the operation despite its unique characteristics. Radical resection was the best treatment modality for resectable pancreatic ACC.

Clinical parameters predicting pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer / 癌症

<p><b>INTRODUCTION</b>Preoperative chemoradiotherapy (CRT), followed by total mesorectal excision, has become the standard of care for patients with clinical stages II and III rectal cancer. Patients with pathologic complete response (pCR) to preoperative CRT have been reported to have better outcomes than those without pCR. However, the factors that predict the response to neoadjuvant CRT have not been well defined. In this study, we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer.</p><p><b>METHODS</b>A total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT, followed by curative surgery, between 2005 and 2013 were included. Patients were divided into two groups according to their responses to neoadjuvant therapy: the pCR and non-pCR groups. The clinical parameters were analyzed by univariate and multivariate analyses, with pCR as the dependent variable.</p><p><b>RESULTS</b>Of the 323 patients, 75 (23.2%) achieved pCR. The two groups were comparable in terms of age, sex, body mass index, tumor stage, tumor location, tumor differentiation, radiation dose, and chemotherapy regimen. On multivariate analysis, a pretreatment carcinoembryonic antigen (CEA) level of ≤ 5 ng/mL [odds ratio (OR) = 2.170, 95% confidence interval (CI) = 1.195-3.939, P = 0.011] and an interval of >7 weeks between the completion of chemoradiation and surgical resection (OR = 2.588, 95% CI = 1.484-4.512, P = 0.001) were significantly associated with an increased rate of pCR.</p><p><b>CONCLUSIONS</b>The pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR. These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.</p>

Age, is it an obstacle for older surgeons to learn laparoscopic approach for colorectal cancer?

Laparoscopic colorectal resection has been extensively accepted for treatment of colorectal cancer. There are several reports about surgeon's age as a factor to have influence on learning laparoscopic approach, and there is no consensus on this point. This study was designed to evaluate the outcomes of laparoscopic colorectal resection in period of learning curve completed by surgeons with different age in order to make clear whether older surgeons may learn laparoscopic approach with more difficulty than younger. From July 2010 to August 2012, the first twenty patients underwent laparoscopic colorectal resection completed by each surgeon were selected for analysis. A total of 240 patients treated by 5 older surgeons with median age of 51 years (range 47-54 years) and 7 younger surgeons with median age of 37 years (range 34-43 years) were divided into group 1 (n = 100) and group 2 (n = 140). The short-term outcomes of laparoscopic surgery of the two groups were compared. Two groups were matched in age, gender, body mass index, American Society of Anesthesiologists (ASA), etc. The median number of lymph nodes harvested was 18 (range 7-63) in group 1 and 16 (range 3-66) in group 2 (P = 0.003); The median operative time in group 1 was 185 min (range 105-480 min) compared to 235 min (range 120-470 min) in group 2 (P < 0.001), and blood loss were 150 ml (range 50-400 ml) and 200 ml (range 50-800 ml), respectively (P < 0.001); Conversion rate in group 2 was lower than in group 1 (12.0 vs 18.6 %, P = 0.196). The mean time to passing of first flatus was 3 day (range 2-5 day) in group 1 and 4 day (range 2-6 day) in group 2 (P = 0.001). Older surgeons can master the laparoscopic skill more easily and quickly. Age is not an obstacle for older surgeons to learn laparoscopic approach for colorectal cancer.

Clinicopathological features and prognosis of primary appendiceal adenocarcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the clinicopathological characteristics and prognostic factors of primary appendiceal adenocarcinoma.</p><p><b>METHODS</b>The clinicopathological data of 42 patients with primary appendiceal adenocarcinoma treated in the Cancer Hospital of Chinese Academy of Medical Sciences between March 1994 and October 2009 were retrospectively analyzed. The survival analysis was conducted using Kaplan-Meier method. The factors influencing survival were analyzed using univariate (Log-rank) and multivariate (Cox) models.</p><p><b>RESULTS</b>A total of 42 patients (29 female and 13 males, median age 56 years) with appendiceal adenocarcinoma were included in this study. Of them, 26 (61.9%) were mucinous adenocarcinoma, 12 (28.6%) were intestinal-type adenocarcinoma and 4 (9.5%) were signet cell carcinoma. 18 patients underwent curative resection, 20 patients received cytoreductive surgery, and 4 patients underwent biopsy only. Thirty patients received systemic chemotherapy (5-Fu-based regimens). One patient who died of postoperative pulmonary embolism on day 8 was excluded from the survival analysis. The overall 1-, 3-, and 5-year survival rate was 80.3%, 46.0% and 38.3%, respectively. Univariate analysis revealed that presence of symptoms of acute appendicitis, curative resection, histological grade, histological subtype, preoperative CEA level, systematic chemotherapy, and stage were all significant factors affecting the survival. Multivariate analysis showed that the preoperative CEA level (P = 0.01), histological grade (P = 0.001), and stage (P = 0.001) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>High level of CEA, G2/3 grade, and advanced stage are associated with poor prognosis in patients with primary appendiceal adenocarcinoma.</p>

Animal experimental study of compression anastomosis ring for low anterior resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of nickel-titanium compression anastomosis ring (CAR27) in colorectal anastomosis after low anterior rectal resection in animal models.</p><p><b>METHODS</b>End-to-end colorectal anastomosis was performed using CAR27 in 6 experimental pigs after resection of the middle and lower third of the rectum. The animals were observed postoperatively for up to 56 days. Five pigs were sacrificed at day 14 and the other at day 56. Distance from anal verge to anastomosis and anastomotic circumference were measured. Histopathologic examination was performed.</p><p><b>RESULTS</b>The median distance from anal verge was 5.3(4-6) cm. No anastomotic leak or other complications were observed. All the pigs recovered and gained weight. In 5 animals sacrificed at day 14, the mean circumference of the anastomosis was 6.8(6.5-7.0) cm, and histopathological examination showed mild inflammatory reaction and fibrosis. In the one sacrificed at day 56, the circumference expanded to 9.3 cm, and no inflammation and fibrosis were observed. Minor adhesion was noticed in only one pig, while smooth and intact serosa in the anastomosis was seen in the rest of the animals.</p><p><b>CONCLUSION</b>CAR27 is a promising device for mid and low colorectal anastomosis.</p>

Prognostic factors of resectable pulmonary metastases from colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic factors for patients who underwent curative resection of pulmonary metastases from colorectal cancer.</p><p><b>METHODS</b>The clinicopathological data of 60 patients with pulmonary metastases from colorectal carcinoma who underwent a radical pulmonary metastasectomy between February 1985 and December 2004 at the Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively reviewed and analyzed.</p><p><b>RESULTS</b>The overall 5-year survival rate was 43.7% after pulmonary excision and 74.0% after colorectal resection. Three factors were identified as significant by univariate log-rank test for overall survival after pulmonary resection, they were preoperative carcinoembryonic antigen, number of pulmonary metastases (solitary vs. multiple), and hilar and/or mediastinal lymph node metastases (P < 0.05). Multivariate analysis showed that number of pulmonary metastases (solitary vs. multiple) and hilar and/or mediastinal lymph node metastasis were independent prognostic factors. However, shorter disease-free interval and more number of pulmonary metastases predicted poor prognosis after primary colorectal resection.</p><p><b>CONCLUSION</b>Pulmonary resection for metastases from colorectal cancer is safe and patients may get long-term survival in selected cases, especially in patients with a solitary pulmonary metastasis and without hilar and/or mediastinal lymph node metastasis.</p>

Association between the number of retrieved lymph nodes in stage II( colorectal cancer radical resection and its prognosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association between the number of retrieved lymph nodes and the prognosis of stage II colorectal cancer.</p><p><b>METHODS</b>Clinical data of 380 patients with stage II colorectal cancer were analyzed retrospectively. SPSS 13.0 was used for data processing. Survival rate was calculated by Kaplan-Meier method, and risk factors related to prognosis of stage II colorectal cancer were analyzed by Logistic regression analysis. Recurrence rate and survival rate were assessed with Chi-squared test.</p><p><b>RESULTS</b>The average number of lymph nodes retrieved from 56 patients who developed recurrence or metastasis in 5 year after surgery was 9.5, and 16.3 from patients who had no recurrence or no metastasis(P<0.01). The number retrieved from 97 patients who died in 5 years after surgery was 11.1, and 16.7 from survivors. Patients were divided into 2 groups:>or=12 group and <12 group. The 5-year survival rate was 83.9% in >or= 12 group and 62.0% in < 12 group, respectively(P<0.01), the recurrence rate was 6.4% in >or=12 group and 25.7% in < 12 group (P<0.01). The univariable analysis showed that the number of retrieved lymph nodes was significantly associated with the survival and recurrence in patients with stage II colorectal cancer (P<0.05).</p><p><b>CONCLUSIONS</b>The number of retrieved lymph nodes is associated with the prognosis of stage II colorectal cancer. Patients with more retrieved lymph nodes have a higher survival rate.</p>