Comparison of outcomes between preservation or division of the uterine round ligament in laparoscopic groin hernia repair in females: a meta-analysis and trial sequential analysis.

PURPOSE: The purpose of this study was to perform a meta-analysis comparing the short-term and long-term outcomes in laparoscopic groin hernia repair with or without preservation of the uterine round ligament (URL) in females. METHODS: We searched several databases including PubMed, Web of Science, Cochrane Library, and and CNKI databases. This meta-analysis included randomized clinical trials, and retrospective comparative studies regarding preservation or division of the URL in laparoscopic groin hernia repair in females. Outcomes of interest were age, BMI, type of hernia, type of surgery, operating time, estimated blood loss, time of hospitalization, seroma, concomitant injury, mesh infection, recurrence, uterine prolapse, foreign body sensation, chronic pain, and pregnancy. Meta-analyses and trial sequential analysis were performed with Review Manager v5.3 and TSA software, respectively. RESULTS: Of 192 potentially eligible articles, 9 studies with 1104 participants met the eligibility criteria and were included in the meta-analysis. There were no significant difference in age (MD-6.58, 95% CI - 13.41 to 0.24; P = 0.06), BMI (MD 0.05, 95%CI - 0.31 to 0.40; P = 0.81), blood loss (MD-0.04, 95% CI - 0.75 to 0.66; P = 0.90), time of hospitalization (MD-0.22, 95% CI-1.13 to 0.69; P = 0.64), seroma (OR 0.71, 95% CI 0.41 to 1.24; P = 0.23), concomitant injury (OR 0.32, 95% CI 0.01 to 8.24; P = 0.68), mesh infection (OR 0.13, 95% CI 0.01 to 2.61; P = 0.18), recurrence (OR 1.13, 95% CI 0.18 to 7.25; P = 0.90), uterine prolapse(OR 0.71, 95% CI 0.07 to 6.94; P = 0.77), foreign body sensation (OR 1.95, 95% CI 0.53 to 7.23; P = 0.32) and chronic pain(OR 1.03 95% CI 0.4 to 2.69; P = 0.95). However, this meta-analysis demonstrated a statistically significant difference in operating time (MD 6.62, 95% CI 2.20 to 11.04; P = 0.0003) between the preservation group and division group. Trial sequential analysis showed that the cumulative Z value of the operating time crossed the traditional boundary value and the TSA boundary value in the third study, and the cumulative sample size had reached the required information size (RIS), indicating that the current conclusion was stable. CONCLUSION: In summary, laparoscopic groin hernia repair in women with the preservation of the round uterine ligament requires a longer operating time, but there was no advantage in short-term or long-term complications, and there was no clear evidence on whether it causes infertility and uterine prolapse.

Prevalence and trend of gonorrhea in female sex workers and men having sex with men in China: a systematic review and meta-analysis.

OBJECTIVES: This systematic review was conducted to estimate the respective prevalence of gonorrhea among two high-risk populations in China and determine the epidemiological features of gonorrhea in them. STUDY DESIGN: Systematic review. METHODS: PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang databases were searched to identify studies published between January 1, 1990, and October 31, 2022, with gonorrhea prevalence tested by polymerase chain reaction among female sex workers (FSWs) and men who have sex with men (MSM). Meta-regression and subgroup analyses were used to investigate potential factors of heterogeneity across studies. Trend analysis of prevalence was conducted by the Jonckheere-Terpstra method. RESULTS: We identified 88 prevalence data points from 49 studies in China, with 30,853 participants of FSWs and 5523 participants of MSM. Pooled prevalence of gonorrhea among FSWs and MSM were 6.9% (95% confidence interval: 4.6-9.7%) and 2.5% (95% confidence interval: 1.5-3.7%), respectively. The subgroup analyses showed there were period, regional, and specimen collection methods diversities among FSWs, and diversities of the regions and specimen collection anatomical sites were found among MSM, in which the prevalence of rectum and pharynx was significantly higher than the urethra. A decreasing trend in the prevalence of gonorrhea was seen among FSWs (z = -4.03) from 1999 to 2021, not found for MSM in China. CONCLUSION: The prevalence of gonorrhea is high in two high-risk groups in China, with extragenital infections requiring particular attention. The findings of this study will provide evidence to formulate national policy and guidance for gonorrhea prevention and control.

[Impact of COVID-19 epidemic on syphilis case reporting in China].

Objective: To analyze the impact of COVID-19 epidemic on syphilis case reporting in China, and provide evidence to evaluate the epidemic situation of syphilis and strengthen the prevention and control of syphilis during COVID-19 epidemic. Methods: The data were collected from the National Notifiable Infectious Disease Reporting System of China Information System for Disease Control and Prevention, National STD Management Information System, and the "nCov2019" R package of github website. The changes of reported cases of syphilis before and during COVID-19 epidemic in China were analyzed. Joinpoint regression model was established by using the reported case number of syphilis from 2010 to 2018, the data in 2019 was used for validation, and the number of syphilis cases in 2020 and 2021 was predicted. The impact of COVID-19 epidemic on the number of syphilis cases was evaluated with calculating the percentage error (PE) between actual number and predicted number of syphilis cases reported.The correlation between reported cases of syphilis and COVID-19 was analyzed by Spearman's correlation analysis. The softwares of Joinpoint 4.9.1.0 and SPSS 18.0 were used for statistical analysis. Results: In 2020 and 2021, the reported cases of syphilis in China decreased significantly by 13.32% and 10.41%, respectively, compared with 2019 (before COVID-19 epidemic), and the reported cases of syphilis in 2021 increased by 3.36% compared with 2020. The reported cases of syphilis in 2020 and 2021 decreased by 17.95% and 20.41%, respectively, compared with predicted numbers. From January to March 2020, the reported monthly case number of syphilis was completely negatively correlated with the confirmed case number of COVID-19 (rs=-1.00, P<0.001). In the provinces with different scales of COVID-19 epidemic, there was also a negative correlation between the monthly reported case number of syphilis and confirmed case number of COVID-19 (all P<0.05). Conclusions: In China, the change of reported cases of syphilis was closely associated with COVID-19 epidemic in 2020 and 2021. Due to the influence of COVID-19 epidemic, the number of reported cases of syphilis decreased significantly, but it should not be thought that syphilis incidence will become a decline trend in the future. It is necessary to carefully and scientifically assess the changes in syphilis epidemic.

[Efficacy comparison of robotic and laparoscopic radical resection of rectal cancer for overweight and obese patients].

Objective: During laparoscopic pelvic operational procedure for obese patients with rectal cancer, the large amount of fat in the abdominal cavity often impairs the exposure of the surgical field, resulting in technical difficulty. In contrast, robotic surgery has the advantages of being more minimally invasive, precise, and flexible. This study compared the clinical efficacy of robotic and laparoscopic radical resection of rectal cancer for overweight and obese patients. Methods: A retrospective cohort study was conducted. Clinical data of 173 patients with rectal cancer and a body mass index (BMI) ≥ 25 kg/m(2) who received robotic or laparoscopic radical rectal resection at the First Affiliated Hospital of Nanchang University from January 2015 to February 2019 were retrospectively collected. Of 173 patients, 90 underwent robotic surgery and 83 underwent laparoscopic surgery. The intraoperative parameters, postoperative short-term and follow-up status were analyzed and compared between the two groups. The follow-up ended in December 2019. Results: Of 173 patients, 103 were male and 70 were female with a median age of 62 (range 29 to 86) years. The average BMI was (27.2±1.6) kg/m(2) in the robotic group and (27.3±1.5) kg/m(2) in the laparoscopic group. No significant differences in baseline data were observed between two groups (all P>0.05). As compared to the laparoscopic group, the robotic group had less intraoperative blood loss [(73.0±46.8) ml vs. (120.9±59.9) ml, t=-5.881, P<0.001] and higher postoperative hospitalization expense [(61±15) thousand yuan vs (52±13) thousand yuan, t=3.468, P=0.026]. The conversion rate in the robotic group was 1.1% (1/90), which was lower than 6.0% (5/83) in the laparoscopic group, but the difference was not statistically significant (P=0.106). There were no statistically significant differences between the two groups in operative time, number of intraoperative blood transfusion, number of harvested lymph nodes, time to the first flatus, postoperative hospital stay and morbidity of total postoperative complications (all P>0.05). Five (6.0%) patients in the laparoscopic group developed urinary dysfunction, while no case in the robotic group developed postoperative urinary dysfunction (P=0.024). The 173 patients were followed up for 8-59 months, with a median follow-up of 36 months. The 3-year overall survival rate of robotic group and laparoscopic group was 89.8% and 86.6%, respectively without significant difference between the two groups (P=0.638). The 3-year disease-free survival rate of the robotic group and the laparoscopic group was 85.6% and 81.5%, respectively without significant difference as well (P=0.638). Conclusions: Robotic radical surgery is safe and feasible for overweight and obese patients with rectal cancer. Compared with laparoscopic radical surgery, it has advantages of clear vision of surgical exposure, less intraoperative blood loss, less pelvic autonomic nerve damage, and operation in a narrow space.

[Key points and skills of assistant in robotic radical gastrectomy for gastric cancer].

An excellent assistant for robotic radical gastrectomy can play an important role in the operation, especially in a initial team. In robotic gastric cancer surgery, an excellent assistant should actively participate in the operation process, choose the appropriate trocar position according to patient's body habitus. Moreover, he should master various surgical instruments skillfully and switch instruments fluently to assist the surgeon to expose key parts during operation, and provide effective help in the operative details, so that the whole operation process can run more smoothly and the operation efficiency and quality will be greatly improved. The growth of the assistants needs constant practice and summary of experience. Meanwhile, the encouragement of the chief surgeon also plays a positive role in promoting the development of the assistants.

LncRNA BLACAT1 regulates the viability, migration and invasion of oral squamous cell carcinoma cells by targeting miR-142-5p.

OBJECTIVE: Oral squamous cell carcinoma (OSCC) is one of the most common head and neck tumors with high incidence and mortality. Long noncoding RNA bladder cancer-associated transcript 1 (lncRNA BLACAT1) was involved in several cancers development. However, the roles of BLACAT1 in OSCC have not been investigated. MATERIALS AND METHODS: The expressions of BLACAT1 and miR-142-5p in OSCC cells were measured by quantitative real-time polymerase chain reaction (qRT-PCR). Cell viability was evaluated by MTT assay. Cell migration and invasion were evaluated by transwell migration assay and transwell invasion assay, respectively. The protein levels of CyclinD1, p21, p27, MMP-2, MMP-9 and MMP-14 were detected by Western blot analysis. The interaction of BLACAT1 and miR-142-5p was verified by luciferase reporter assay. RESULTS: The expression of BLACAT1 was increased and the expression of miR-142-5p was decreased in OSCC cells. The knockdown of BLACAT1 suppressed the viability, migration and invasion of OSCC cells. miR-142-5p was identified as a target of BLACAT1 and BLACAT1 overexpression suppressed miR-142-5p expression. Furthermore, overexpression of miR-142-5p showed similar effects on OSCC cells viability, migration and invasion with BLACAT1 knockdown, and inhibition of miR-142-5p restored the effects of BLACAT1 knockdown OSCC cells viability, migration and invasion. CONCLUSIONS: LncRNA BLACAT1 knockdown suppressed the viability, migration and invasion of OSCC cells by sponging miR-142-5p, indicating that BLACAT1 might be a novel target for the treatment of OSCC.

[Study on clinical classification of Japanese encephalitis by Bayes discriminant analysis].

Objective: To construct Bayes discriminant function for clinical classification of common and severe Japanese encephalitis (JE) cases, and to identify cases accurately with quantitative indicators. Methods: Samples of confirmed common and severe JE cases reported by the epidemic surveillance system of Gansu Provincial Center for Disease Control and Prevention from 2005 to 2017 were collected. Non-conditional logistic regression analysis and Bayes stepwise discriminant analysis were used to screen meaningful clinical indicators, so as to construct and evaluate Bayes discriminant function. Results: There were 256 common JE cases and 257 severe JE cases. There were no significant differences in sex, age and occupation distributions between the two groups (P>0.05) and there was significant difference in case fatality rate (P<0.05). Non-conditional logistic regression analysis and Bayes stepwise discriminant analysis, combined with using related literature, to screen 11 clinical indicators for the construction of Bayes discriminant function. Interactive validation showed that the sensitivity of discriminant function was 71.48% (95%CI: 65.53%-76.93%) and the specificity was 73.93% (95%CI: 68.11%-79.19%). The area under ROC curve was 0.761 (95%CI: 0.720-0.803) and the total accuracy rate was 72.71%. Conclusion: Bayes discriminant function can be used to identify common and severe JE cases more accurately, which is helpful for the reasonable treatment and good prognosis of JE patients.

Tissue- and breed-specific expression of the chicken fat mass- and obesity-associated gene (FTO).

The fat mass- and obesity-associated gene (FTO) is involved in energy metabolism, but little is known about the chicken FTO gene. The objective of the current study was to detect chicken FTO expression patterns in the hypothalamus, liver, and skeletal muscle during development, and analyze the effects of age and breed on FTO expression. Real-time quantitative polymerase chain reaction results revealed that chicken FTO mRNA was expressed in all of the tissues tested. Chicken FTO exhibited tissue- and breed-specific patterns in the recessive White Plymouth Rock chicken and the Qingyuan partridge chicken. The highest FTO expression level was in the hypothalami of 1-week-old chicks. FTO mRNA was expressed more in the breast muscles and livers of recessive White Plymouth Rock chickens than those of Qingyuan partridge chickens at 1 and 8 weeks of age. These results indicate that FTO probably plays a significant role in energy metabolism at 1 week old, when chicks have undergone metabolic adaptations from yolk dependence to the utilization of exogenous feed.

Upregulation of NRAMP1 mRNA confirms its role in enhanced host immunity in post-artificial infections of Salmonella enteritidis in chicks.

1. Salmonella enteritidis (SE) is reported as the most common food-borne pathogen transmitted through poultry products. The natural resistance-associated macrophage protein 1 (NRAMP1) is a candidate gene associated with SE-mediated immune response and is related to the phagocytosis of SE. In this study, the classical single-nucleotide polymorphism (SNP) G2357A in exon 8 of the NRAMP1 gene was detected. The expression of NRAMP1 mRNA was first investigated in heterophil granulocytes and spleen in chicks from two different Chinese native breeds at 1, 3 and 10 d post-infection. In addition, the association with the effect of SE challenge was identified. 2. The G2357A SNP showed no significant association with Salmonella natural infection in birds from two different Chinese native breeds. 3. The upregulation of NRAMP1 mRNA in heterophils and spleen was involved in the response to pathogenic SE colonisation during the acute infection period in chicks. The results suggest that genetics, age, gender and interactions among these factors play important roles in the modulation of NRAMP1 mRNA expression and copy number by SE-mediated immune response in different Chinese chickens. 4. In conclusion, the enhancement of host immunity mediated by the upregulation of NRAMP1 mRNA in heterophil granulocytes and spleen might be more obvious and earlier in the chicks resistant to infections with SE than in susceptible chicks.

Molecular genetic diversity and maternal origin of Chinese black-bone chicken breeds.

Chinese black-bone chickens are valued for the medicinal properties of their meat in traditional Chinese medicine. We investigated the genetic diversity and systematic evolution of Chinese black-bone chicken breeds. We sequenced the DNA of 520 bp of the mitochondrial cyt b gene of nine Chinese black-bone chicken breeds, including Silky chicken, Jinhu black-bone chicken, Jiangshan black-bone chicken, Yugan black-bone chicken, Wumeng black-bone chicken, Muchuan black-bone chicken, Xingwen black-bone chicken, Dehua black-bone chicken, and Yanjin black-bone chicken. We found 13 haplotypes. Haplotype and nucleotide diversity of the nine black-bone chicken breeds ranged from 0 to 0.78571 and 0.00081 to 0.00399, respectively. Genetic diversity was the richest in Jinhu black-bone chickens and the lowest in Yanjin black-bone chickens. Analysis of phylogenetic trees for all birds constructed based on hyplotypes indicated that the maternal origin of black-bone chickens is predominantly from three subspecies of red jungle fowl. These results provide basic data useful for protection of black-bone chickens and help determine the origin of domestic chickens.

Transcriptional co-activator PGC-1α gene is associated with chicken skeletal muscle fiber types.

The peroxisome proliferators-activated receptor-γ coactivator-1α (PGC-1α) is a candidate gene for meat quality traits because of its prominent role in muscle fiber type switching and determination. We investigated the effects of the PGC-1α gene on chicken skeletal muscle fiber type switching and on other meat quality traits. Single nucleotide polymorphisms were detected by PCR-SSCP and DNA sequencing, and then genotyping was performed by PCR-ligation detection reaction methods. Skeletal muscle fiber types, intramuscular fat content, shear forces, and water loss rate of the gastrocnemius lateralis muscle were measured in Qingyuan Partridge chickens and Recessive White chickens. Four SNPs, C171T in exon2, C384T in exon3, G646A in exon5, and A948G in exon8 were detected. Marker-trait association analysis indicated that G646A polymorphism was associated with skeletal myofiber type and that H1 (CCAA) was the most advantageous haplotype for skeletal myofiber type. We concluded that polymorphisms of the PGC-1α gene and their haplotypes are associated with chicken skeletal myofiber type traits.

Oesophageal squamous cell carcinoma: relationship between fluorine-18 fludeoxyglucose positron emission tomography CT maximum standardised uptake value, metabolic tumour volume, and tumour, node and metastasis classification.

OBJECTIVES: We aimed to evaluate the relationships between primary tumour, maximum standardised uptake value, metabolic tumour volume and seventh edition American Joint Committee on Cancer (AJCC) classification in oesophageal squamous cell carcinoma (OSCC) patients. METHODS: Fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)-CT scans of 41 consecutive newly diagnosed OSCC patients were retrospectively reviewed. Maximum standard uptake value (SUV(max)) and metabolic tumour volume (MTV) were recorded. Two-tailed Spearman's correlation was used to analyse the relationships between the metabolic parameters and the AJCC staging system. RESULTS: Positive correlations were observed between SUV(max), MTV and tumour (T) stage, in addition to node (N) stage and AJCC stage. Both metabolic parameters were independent variables that significantly affected the N stage and AJCC stage, and SUV(max) was the only independent variable that significantly affected the T stage. CONCLUSION: The metabolic parameters derived from (18)F-FDG PET-CT were positively correlated with T, N and AJCC stage in primary OSCC. Our findings may suggest a complementary role of these parameters to seventh-edition AJCC staging in the prognostication of OSCC patients.

Two maternal origins of Chinese domestic goose.

China is particularly rich in goose genetic resources. Systematic study of the genetic diversity and origin of Chinese domestic geese will provide an important scientific basis for the conservation and utilization of these resources and for human history. The 521-bp control region (D-loop) of mitochondrial DNA from 26 goose breeds and 6 Landaise geese were sequenced. The results showed that the average haplotype diversity and nucleotide diversity of Chinese domestic geese were 0.1384 and 0.00029, respectively. Shared haplotype analysis and systematic evolution analysis revealed that Chinese domestic geese had 2 maternal origins. The Yili goose breed originated from the Greylag goose (Anser anser), and the other 25 domestic goose breeds originated from the swan goose (Anser cygnoides). An interesting finding was that 1 Linxian white goose and 1 Wanxi white goose shared the same H4 haplotype with the Rhine goose and the Landaise goose, which originated from the Greylag goose (A. anser). Further research on this finding is planned.

Fermi resonance and its effect on the mean transition time and rate.

Fermi resonance and its effect on the mean transition time and rate are studied. The necessary frequency ratio 1:2 for Fermi resonance to occur is explained by applying the deterministic averaging method to the two-dimensional conservative Pippard system, and a more frequent fluctuation of energy process due to Fermi resonance is shown by using the samples obtained from digital simulation of the stochastic Pippard system. In the case of weak coupling, the mean transition time of the reacting oscillator energy is evaluated for both nonresonance and Fermi resonance by using the standard (Stratonovich) stochastic averaging method. The theoretical results for the mean transition time in the case of Fermi resonance and nonresonance is then extended to the stochastic system with bistable potential, and the effects of frequency ratio and coupling coefficient on the mean reaction rate are analyzed. In the case of strong coupling, it is pointed out that the exciting oscillator and reacting oscillator move together like one oscillator and no Fermi resonance can occur. In this case, the mean transition rate of the system total energy is studied by using the stochastic averaging method for quasi-non-integrable Hamiltonian systems. All the theoretical results are confirmed through comparison with those from digital simulation, and the effect of Fermi resonance on the transition time and rate is discussed.

Stochastic analysis of a pulse-type prey-predator model.

A stochastic Lotka-Volterra model, a so-called pulse-type model, for the interaction between two species and their random natural environment is investigated. The effect of a random environment is modeled as random pulse trains in the birth rate of the prey and the death rate of the predator. The generalized cell mapping method is applied to calculate the probability distributions of the species populations at a state of statistical quasistationarity. The time evolution of the population densities is studied, and the probability of the near extinction time, from an initial state to a critical state, is obtained. The effects on the ecosystem behaviors of the prey self-competition term and of the pulse mean arrival rate are also discussed. Our results indicate that the proposed pulse-type model shows obviously distinguishable characteristics from a Gaussian-type model, and may confer a significant advantage for modeling the prey-predator system under discrete environmental fluctuations.

Rapid release of intracellular galectin-3 from breast carcinoma cells by fetuin.

Galectin-3, a beta-galactoside binding protein, plays a significant role in cell to extracellular matrix interactions. Despite its extracellular expression, the precise physiological mechanisms that trigger its release from the intracellular milieu have not been characterized. The present analyses were, therefore, done to identify the extracellular matrix proteins with propensity to induce the release of intracellular galectin-3 from breast carcinoma cells. Our studies demonstrate that fetuin, a serum glycoprotein that is abundant in the fetal serum, is capable of inducing the rapid release (approximately 1 min) of intracellular galectin-3 from the cells. The mechanism by which galectin-3 is rapidly released appears to be novel and does not depend on changes in intracellular calcium levels. We also report that galectin-3-expressing breast carcinoma cells in serumless medium adhere and spread well on microtiter wells in the presence of fetuin and divalent ions in a carbohydrate-dependent manner. The data suggest that fetuin is a natural modulator of galectin-3 secretion/release and that the secreted galectin-3 modulates the activity of cell surface receptors for extracellular matrix proteins.

[Application of BRL conditioned medium in ES cells culture].

AIM: To study the method of using BRL conditioned medium in ES cells culture. METHODS: ES cells were cultured in BRL conditioned medium, MEF feeder layer, and BRL conditioned medium plus MEF feeder layer respectively. Both the numbers of ES cells and embryonic bodies and the differentiated cells around the ES cell colonies at certain stages were studied to find the differences of growing speed of ES cells in three culture mediums. RESULTS: On promoting the growth and maintaining the undifferentiated state of ES cells at the early stage after recovery, the effects of BRL conditioned medium were less than those of MEF feeder layer and those of BRL conditioned medium plus MEF feeder layer (P < 0.01), and there was no difference between MEF feeder layer and BRL conditioned medium plus MEF feeder layer (P > 0.05). CONCLUSION: ES cells should be cultivated on MEF feeder layer or in BRL conditioned medium plus MEF feeder layer at the early stage after recovering.

[The surgical treatment of gastric stump cancer: an analysis of 26 cases].

26 patients with gastric stump cancer were treated by surgery plus chemotherapy or radiotherapy in our hospital from 1970 to 1992. 20 patients were qubiected to surgery plus chemotherapy 12 patients were operable six patients had simple radiotherapy. These patients were followed up to the end of 1992. Using Kaplan Meier method and log-rank test (P < 0.05), we analysed the factors effecting the survival rate and drew a conclusion that surgical treatment plus adjuvant chemotherapy is the treatment of choice, and if no-resection, we would treat it with chemotherapy rather than radiotherapy.

Treatment of locally recurrent soft tissue sarcomas of the retroperitoneum: report of 30 cases.

To assess the results in treating locally recurrent soft tissue sarcomas of the retroperitoneum, we reviewed the clinical, therapeutic, and pathologic characteristics of 30 patients who underwent surgical exploration. Complete resection was achieved in 18 patients (60%), 6 with en bloc resection of adjacent organs involved by the tumors. Following the first operation for recurrent lesions, the median survival was 33 months for those undergoing complete resection and 14 months for those undergoing partial resection or biopsy (P = 0.04). Patients with a disease-free interval (DFI) of > 24 months were associated with better prognosis than those with DFI of < or = 24 months (median survival: 40 months vs. 17 months, P = 0.03). Patients with tumor size of < or = 20 cm had longer survival than those with tumor size of > 20 cm (median survival: 39 months vs. 23 months, P = 0.04). Among 14 patients who received adjuvant radiation therapy, four patients whose tumors had been considered unresectable at first exploration for recurrence underwent complete resection after preoperative radiation therapy. An aggressive surgery aimed at complete resection in treating recurrent retroperitoneal sarcomas is strongly recommended. We suggest that in large tumors preoperative radiation therapy should be used to reduce the tumor volume and therefore a higher rate of complete resection may be achieved.

Total pelvic exenteration for locally advanced rectal carcinoma.

Total pelvic exenteration was performed in 31 patients (30 males and 1 female) who had rectal cancers involving adjoining pelvic structures. Twenty-nine patients had primary tumors and two had recurrent diseases after previous abdominoperineal resection. Preoperative irradiation was used in nine patients with fixed tumors. When performing the surgical procedure, we also actively employed lateral node dissection to make the operation more radical. Three patients (one with primary tumor and two with recurrent) underwent the exenteration with partial sacrectomy because of the sacral involvement and they all died of local failure within 15 months. The overall 5-year survival rate was 52 percent for all patients and 56 percent for those who had primary tumors. The results suggest that total pelvic exenteration with lateral node dissection should be performed for locally advanced rectal cancer if the tumor is not completely fixed to the pelvic wall and preoperative irradiation should be used to convert a fixed tumor to a resectable one.