[Application value of dual channel dual curved endoscope in the endoscopic submucosal dissection for gastric angle mucosal lesions].

Objective: To evaluate the clinical value of dual channel dual curved endoscope in the endoscopic submucosal dissection (ESD) for gastric angle mucosal lesions. Methods: A descriptive cohort study was carried out. Clinicopathological data of 20 cases with gastric angle mucosal lesions undergoing ESD by dual channel dual curved endoscope in our center from October 2016 to August 2018 were collected and analyzed retrospectively. Inclusion criteria: (1) the lesion was located in the gastric angle confirmed by gastroscopy before ESD. (2) CT examination showed no distant metastasis. (3) pathological biopsy confirmed precancerous lesion or early cancerous lesion without submucosal invasion. (4) the whole operation was performed by the same endoscopist with ESD experience of about 2000 cases. Patients with previous ESD history of gastric angle and other serious diseases were excluded. The dual channel dual curved endoscopy (Olympus, GIF-2TQ260M) and other conventional endoscopic surgical instruments were used in all the cases. Complete tumor resection rate, pathological results, intraoperative and postoperative complications, operation time and hospitalization time were observed. Follow - up parameters included residual tumor, local recurrence and heterogeneous lesion. Results: Of 20 patients, 14 were male and 6 were female with an average of 55.6 years (range, 37 to 75). All the tumors located in gastric angle. Specimen size ranged from 1.2 to 5.5 (average 2.9) cm. Operation time ranged from 50 to 120 (average 85.8) minutes. Hospital stay ranged from 3 to 7 (average 5.1) days. The en bloc excision was performed successfully in all 20 cases. There was no perforation or bleeding during or after operation. Pathological results showed curative or nearly curative resection stage in all the cases. No tumor residual or recurrence was found during follow-up for 8 to 30 (average 18.5) months. Conclusion: Dual channel dual curved endoscope can provide good vision and easy control in removing the lesion completely and avoiding complications during the ESD procedure in gastric angle mucosal lesions with good long-term efficacy.

Application value of dual channel dual curved endoscope in the endoscopic submucosal dissection for gastric angle mucosal lesions / 中华胃肠外科杂志

Objective@#To evaluate the clinical value of dual channel dual curved endoscope in the endoscopic submucosal dissection (ESD) for gastric angle mucosal lesions.@*Methods@#A descriptive cohort study was carried out. Clinicopathological data of 20 cases with gastric angle mucosal lesions undergoing ESD by dual channel dual curved endoscope in our center from October 2016 to August 2018 were collected and analyzed retrospectively. Inclusion criteria: (1) the lesion was located in the gastric angle confirmed by gastroscopy before ESD. (2) CT examination showed no distant metastasis. (3) pathological biopsy confirmed precancerous lesion or early cancerous lesion without submucosal invasion. (4) the whole operation was performed by the same endoscopist with ESD experience of about 2000 cases. Patients with previous ESD history of gastric angle and other serious diseases were excluded. The dual channel dual curved endoscopy (Olympus, GIF-2TQ260M) and other conventional endoscopic surgical instruments were used in all the cases. Complete tumor resection rate, pathological results, intraoperative and postoperative complications, operation time and hospitalization time were observed. Follow - up parameters included residual tumor, local recurrence and heterogeneous lesion.@*Results@#Of 20 patients, 14 were male and 6 were female with an average of 55.6 years (range, 37 to 75). All the tumors located in gastric angle. Specimen size ranged from 1.2 to 5.5 (average 2.9) cm. Operation time ranged from 50 to 120 (average 85.8) minutes. Hospital stay ranged from 3 to 7 (average 5.1) days. The en bloc excision was performed successfully in all 20 cases. There was no perforation or bleeding during or after operation. Pathological results showed curative or nearly curative resection stage in all the cases. No tumor residual or recurrence was found during follow-up for 8 to 30 (average 18.5) months.@*Conclusion@#Dual channel dual curved endoscope can provide good vision and easy control in removing the lesion completely and avoiding complications during the ESD procedure in gastric angle mucosal lesions with good long-term efficacy.

Clinical efficacy of laparoscopic vagus nerve and pylorus-preserving gastrectomy for early gastric cancer / 中华消化外科杂志

Objective To investigate the clinical efficacy of laparoscopic vagus nerve and pylorus-preserring gastrectomy (LVNPPG) for early gastric cancer.Methods The retrospective descriptive study was conducted.The clinical data of 5 patients who underwent LVNPPG for early gastric cancer at the Peking University Cancer Hospital between May 2016 and September 2016 were collected.Patients underwent laparoscope-assisted or total laparoscopic vagus nerve (hepatic branch and celiac branch) and pylorus-preserving gastrectomy.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) postoperative pathological examination;(4) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor metastasis and recurrence up to December 2016.Measurement data with normal distribution was represented as average (range).Results (1) Surgical situations:of 5 patients undergoing successful LVNPPG,digestive tract reconstruction using auxiliary incision was conducted in 3 patients and total laparoscopic surgery in 2 patients.Three patients received appliance side-to-side anastomosis and 2 received manual end-to-end anastomosis.Hepatic branch and celiac branch of vagus nerve in 5 patients were preserved.Average operation time and volume of intraoperative blood loss were 220 minutes (range,180-305 minutes) and 108 mL (range,30-216 mL).(2) Postoperative situations:average time to initial bowel exsufflation,average times for fluid diet intake and for semifluid diet intake were 3 days (range,2-4 days),3 days (range,1-5 days)and 10 days (range,5-25 days),respectively.One patient complicated with delayed gastric emptying was improved by conservative treatment.Duration of hospital stay of 5 patients was 13 days (range,7-32 days).(3)Postoperative pathological examination:number of lymph node dissected,average lengths of proximal margin and distal margin were 22 (range,15-35),3.5 cm (range,2.2-5.0 cm) and 3.7 cm (range,2.0-5.5 cm),respectively.Pathological T stage:pT0 stage was detected in 1 patient,pT1a stage in 1 patient,pT1b stage in 2 patients and pT2 stage in 1 patient.Pathological N stage:pN0 stage was detected in 3 patients and pN2 in 2 patients.Pathological TNM stage:0 stage was detected in 1 patient,Ⅰ a stage in 2 patients,Ⅱ a stage in 1 patient and Ⅱb stage in 1 patient.Two patients had stage migration,including from cT1N0 to pT2N2 and from cT0N0 to pTlbN2.(4) Follow-up situations:5 patients were followed up for 2.8-7.0 months,with a median time of 5.6 months.During follow-up,there were no death and occurrence of tumor metastasis and recurrence.Conclusion LVNPPG is safe and feasible for early gastric cancer.

Updates on lymph node metastasis in early gastric cancer / 中华消化外科杂志

Japanese gastric cancer treatment guidelines list options for treatment of each stage of early gastric cancer (EGC).The treatment of EGC is closely related to the lymph node metastasis, and the accurate prediction of lymph node metastasis is related to the choice of the treatment options and the prognosis of the patients.The lymph node metastasis of EGC is evaluated according to the clinicopathological factors, imaging,molecular markers and sentinel lymph node (SLN) tracer biopsy.A two-step method for the management of EGC treated with endoscopic mucosal resection/endoscopic submucosal dissection (EMR/ESD) is recommended.While for those EGC patients not suitable to receive EMR/ESD, imaging or molecular marker and SLN tracer biopsy technology are applied to determine lymph node status.

Relationship between clinicopathologic factors and prognosis of patients with early gastric cancer / 中华消化外科杂志

Objective To investigate the relationship between various clinicopatholngic factors and prognosis of early gastric cancer. Methods The clinical data of 459 patients with early gastric cancer who had undergone gastrectomy combined with extended (D2) lymphadenectomy at Zhongshan Hospital from January 2002 to October 2007 were retrospectively analyzed. Survival was calculated using the Kaplan-Meier method, and clinicopathologic factors such as age, sex, tumor size, gross morphology, tumor differentiation, depth of invasion, lymphatic vessels involvement and lymph node metastasis were analyzed using the Cox regression model. Univariate analysis was done by Log-rank test. Results Univariate analysis demonstrated that tumor size and differentiation, depth of invasion, lymphatic vessels involvement and lymph node metastasis significantly affected survival in patients with early gastric cancer (χ~2 = 8.476, 6.210, 4.014, 14. 197, 55.027, P < 0.05). The status of lymph node metastasis was an independent predictor of survival in patients with early gastric cancer, and the more metastatic lymph nodes detected, the greater the influence on the prognosis. Conclusions Lymph node metastasis is the most important factor influencing the prognosis of early gastric cancer. Appropriate lymph node dissection is necessary, especially for patients with risk factors associated with lymph node metastasis.