ObjectiveTo study and analyse the correlation between biologic behavior and clinical factors in gastric cancer.MethodsClinical and pathological study of carcinoma of stomach were retrospectively made in 1034 patients. ResultsIn this series,148 of 1034 patients (14.3%) were early gastric cancer.The frequency of lymph nodes metastasis was higher in proximal gastric cancer than distal (P＜0.0001).Similar frequency can also be seen in the tumor of larger diameter (P＜0.01),deeper invasion (P＜0.0001) and poor differentiation (P=0.004).Some difference in ages and sex of patients may be found on the invasion (P=0.003),differentiation (P＜0.0001),site (P＜0.001) and frequency of lymph nodes metastasis of the tumor (P=0.01).In multifactorial multivariate linear regression analysis,the site of tumor (P=0.003),diameter of tumor (P＜0.0001),depth of tumor infiltration (P＜0.0001) and the cell differentiation showed significant association with lymph node metastasis,in which the female patient had more lymph node metastasis than male (P＜0.001).Depth of tumor infiltration was the most important factor in lymph node metastasis.Numbers of lymph nodes resected were much more in total and distal gastrectomies than that in proximal gastrectomy (P＜0.0001). ConclusionThe results of this study suggest that radical gastrectomy with lymphadenectomy is necessary even in all stages of gastric cancer.
Objective To evaluate the clinical application of hand assisted laparoscopic radical surgery for gastric cancer. Methods From June 2010 to September 2011，a series of 51 patients were undertook hand assisted laparoscopic D2 gastrectomy （hand assisted group），49 patients were undertook laparoscopic assisted D2 gastrectomy （laparoscopic group），the secure indexes of surgery effect in perioperative period were compared betwee two groups. Results The incision length was （6.82±0.33） cm and （5.74±1.11） cm （t=6.57，P=0.00），numbers of harvested lymph nodes were 16.10±5.11 and 14.16±3.60 （t=2.18，P=0.03），intraoperative bleeding was （249.40±123.40） ml and （251.00±90.40） ml （t=-0.74，P=0.94），operation time was （177.7±23.8） min and （188.1±16.9） min （t=-2.53，P=0.01），postoperative hospital stay was （11.12±5.02） d and （10.88±3.13） d （t=0.29，P=0.78） in the hand assisted group and in the laparoscopic group，respectively. One case of gastric atony happened in the hand assisted group，one case of gastric atony and incision infection happened in the laparoscopic group. No mortality case was found in two groups. Conclusions Hand assisted laparoscopic D2 gastrectomy is less difficult，and shorter operation time，and considerable treatment effection as compared with laparoscopic operation.
In perioperation period, the dynamic changes of solubla interleulcin-2 receptor (sIL-2R) in serum were determined by ELISA in 60 patients with gastric cancer (GC), and then was compared with those of 30 normal individuals and 40 selective patients who necieved common abdominal surgery. Results: At the day before and ten days after operation, the sIL-2R of patients with GC was higher than that of normal individual. But twenty days after operation, the sIL-2R reduced to as normal level. Conclusion: As a immunodepressive index, the sIL-2R of patients with GC was increased obviously, and after radical gastrectomy, it decreased gradually. So by determining sIL-2R, we can evaluate the immunologic function of patientswith GC.
Objective To investigate the differences of postoperative quality of life （QOL） between proximal gas-trectomy （PG） and total gastrectomy （TG） in patients with adenocarcinoma of esophagogastric junction （AEG）. Methods Eighty five patients with AEG （Siewert type Ⅱ or Ⅲ） who were underwent PG or TG surgery between Jan. 2011 andMar. 2012 at West China Hospital of Sichuan University were enrolled， to measure the QOL by using the Chineseversion of quality of life questionnaire core-30 （QLQ-C30） and the site-specific module for gastric cancer （QLQ-STO22）which were drawed up by the European Organization for Research and Treatment of Cancer （EORTC） in 12 months afteroperation. Results There were no any difference of clinicopathological features between patients in 2 groups （P＞0.05），such as age， gender， and so on. The scores of eating restriction， diarrhea， and dyspnea in PG group were lower than those of TG group （P＜0.05）， but scores of reflux and taste change were higher （P＜0.05）， no other significant differ-ence was found between the patients of 2 groups （P＞0.05）. Conclusion Both of PG＋gastric tube reconstruction and TG＋Roux-en-Y anastomosis in treatment of patients with Siewert type Ⅱ or Ⅲ AEG may lead to complications， but patients who underwent former surgery have better situation in eating restriction， diarrhea， and dyspnea， and patients who underwent later surgery have better situation in reflux and taste change.
ObjectiveTo investigate the application of three methods about digestive tract reconstruction in radical resection for proximal gastric cancer.MethodsWe retrospectively reviewed the cases of 130 proximal gastric cancer patients who underwent double tract reconstruction (TD, 35 cases), total gastrectomy (TG, 50 cases) and esophagogastrostomy (EG, 45 cases) from Jan. 2016 to Oct. 2018 in Gastrointestinal Surgery Department in our Hospital.ResultsThere were no significant differences in basic data of patients, preoperative nutritional status, hemoglobin content, postoperative recovery time of gastrointestinal function, hospitalization time and early postoperative complications among the three groups (P>0.05). But the operative time, intraoperative bleeding volume, postoperative status of total protein, albumin, hemoglobin, late complications, reflux symptoms, gastro-intestinal quality of life index (GIQLI) between the three groups had statistically significant differences (P<0.05). The operative time of EG was (161.80±30.77) min, which was the shortest. The intraoperative bleeding volume of TG was (107.20±10.70) mL, which was the most. At 6 months after TG, the total protein, albumin and hemoglobin were (62.15±6.72) g/L, (36.14±6.57) g/L and (112.68±16.97) g/L, respectively, which were the lowest level among the three groups. There late complications of the EG were the most serious, in which the Visick score was 46 and the GIQLI index was 103.56±22.01. The above differences were statistically significant (P<0.05).ConclusionsDT performs better in anti-reflux, maintenance of postoperative nutrition, and anti-anemia, but the occurrence of remnant gastric cancer is a potential risk. TG has a lot of bleeding, as well as the performance of postoperative nutrition and anti-anemia is not good, but it can avoid the occurrence of remnant gastric cancer. The operative time of EG is short, but reflux symptoms are more likely to occur after surgery, and the quality of life is bad.
ObjectiveTo evaluate the lymphatic tracing effects of nano-carbon particles for radical gastrectomy. MethodsTotally eighty-six cases of gastric cancer patients were randomly divided into experimental group (n=43) and control group (n=43). In the experimental group, nanocarbon was injected into the subserosa around the tumor for lymphatic tracing before operation, while no tracer was given in the control group. Then the number of lymph nodes dissected, operation time, and postoperative complications of patients were compared. ResultsThe number of lymph nodes dissected in patients of experimental group was 30.20±11.63 (17-45), which was significantly more than that of control group 〔22.47±7.60 (15-31)〕, Plt;0.05. The blacken rate of lymph nodes in patients of the experimental group was 74.56% (1 260/1 690). Of 302 metastatic lymph nodes, the blacken rate of metastatic lymph nodes was 61.26% (185/302), which was significantly higher than the nonblacken rate of metastatic lymph nodes (38.74%, 117/302), Plt;0.05. The operation time of patients in experimental group 〔(3.51±0.43) h〕 was not different from that in control group 〔(3.49±0.51) h〕, Pgt;0.05. The postoperative complications of patients in two groups was not different and no local or systemic adverse reaction occurred in patients of experimental group. ConclusionSubserosal injection of nanocarbon particles around the tumor is safe and can provide the guidance to lymph node dissection in radical gastrectomy.
Objective To find out some ideal reconstructions after total gastrectomy in experimental study of rat. Methods Sixty male Sprague-Dawley rats were randomly and averagely divided into 6 groups: Roux-en-Y group (RY group), proximate jejunal pouch group (PJP group), distal jejunal pouch group (DJP group), two jejunal pouchs group (TJP group), duodenumjejunal pouch interposition group (DJPI group) and laparotomy group (L group). Body weight of rats, intestinal transit distance, adaptive changes in esophagojejunostomic mucosa and morphology changes of intestine after operation were observed and compared. Results At 2 weeks after operation, body weight in each group were significantly lower than that before operation （P＜0.05）. At 4 weeks postoperatively, body weight in PJP group, TJP group and DJPI group were significantly higher than that in RY group respectively （P＜0.05）, as well as at 8 weeks. Intestinal transit distance in PJP group was shorter than that in RY group （P＜0.05）. With regard to intestinal mucosa, TJP group and DJPI group were significantly different with RY group （P＜0.05）. Interestingly, there was no difference in each group as to refluxing esophagitis （P＞0.05）. Conclusion Proximate and two jejunal pouchs Roux-en-Y esophagojejunostomy seem to be ideal procedures for digestive tract reconstruction after total gastrectomy. The jejunal pouch interposition procedure seems to be same effective to PJP and TJP, but there is no preponderance over the former.
Objective To compare short-term effects of totally laparoscopic total gastrectomy (TLTG) and laparoscopic assisted total gastrectomy (TATG) in treatment of resectable gastric cancer. Methods The EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI, and WanFang Data databases were searched by computer. According to the inclusion and exclusion criteria of the literatures, the comparative research literatures were selected. The relevant data were extracted and the literature evaluation was applied. The Revman 5.3 software was applied for the meta-analysis. Results A total of 11 articles (6 Chinese literatures, 5 English literatures) were included, including 1 491 patients clinically diagnosed with the gastric cancer. The results of meta-analysis showed: compared with the LATG group, the TLTG group had the less intraoperative blood loss ［MD=–17.59, 95% CI (–30.81, –4.37), P=0.009］, shorter incision length ［MD=–4.50, 95% CI (–4.92, –4.09), P<0.000 01］, and earlier first anal exhaust time ［MD=–0.16, 95% CI (–0.28, –0.04), P=0.007］in the treatment of gastric cancer; Besides, the first time of postoperative fluid intake of the TLTG group was earlier ［MD=–0.47, 95% CI (–0.86, –0.08), P=0.02］ and the postoperative hospital stay of the TLTG group was shorter ［MD=–0.59, 95% CI (–0.94, –0.24), P=0.000 9］; In the TLTG group, the VAS score was lower on the first postoperative day ［MD=–3.10, 95% CI (–3.48, –2.72), P<0.000 01］ and on the third postoperative day ［MD=–2.30, 95% CI (–2.57, –2.03), P<0.000 01］. There were no significant differences in the operation time, proximal margin distance, distal margin distance, lymph node dissection, and postoperative adverse reactions between the two groups (P>0.05). The subgroup analysis of the postoperative adverse reactions showed that there were no significant differences in the anastomotic stricture, anastomotic leakage, and anastomotic bleeding (P>0.05). Conclusions TLTG has some advantages of less bleeding, shorter incision, earlier ventilation and feeding, shorter postoperative hospital stay, and light postoperative pain in treatment of resectable gastric cancer. However, due to quantitative and qualitative limitations of included studies, above conclusions still need to be carried out more and high quality researches are validated.
ObjectiveTo explore the effect of exogenous ghrelin on early recovery of rats after subtotal gastrectomy. MethodsTwelve rats undergoing subtotal gastrectomy (B-Ⅰtype) were randomly divided into two groups, and saline or ghrelin was intraperitoneally injected in two groups, respectively. The body weight and daily food intake were measured before operation and on 1-7 d after operation. Rats were killed on day 7 after operation and the expressions of ghrelin mRNA in the fundus of stomach and anastomotic stoma was determined by realtime fluorescent quantitative PCR assay. The anastomotic bursting pressure and hydroxyproline content of anastomotic stoma tissues were also detected. ResultsThere was no significant difference (P＞0.05) in pre and postoperative body weight between two groups. Gradual decrease in postoperative body weight among the rats of saline group was observed which was significantly lower than that before operation (Plt;0.01). Body weight reached it’s lowest on day 1 after operation (Plt;0.01), after which it gradually increased but was still lower than that before operation (Plt;0.01). The postoperative body weight of rats in ghrelin group gradually decreased too, and was also significantly lower than preoperative body weight (Plt;0.01), except for the day 1 after operation (P=0.693). It reached the lowest on day 4 after operation (Plt;0.01), then it gradually increased but was still lower than that before operation (Plt;0.05 or Plt;0.01). The cumulative food intake of rats in ghrelin group was （52.50±6.77） g, which was significantly higher than that in saline group 〔(45.67±7.47) g〕, Plt;0.05. On day 7 after operation, relative expression of ghrelin mRNA in the fundus of stomach of rats in ghrelin group was 0.08±0.04, which was significantly lower than that in saline group (0.22±0.07), Plt;0.01. Compared with saline group, ghrelin-treated rats displayed significantly higher bursting pressure 〔（155.83±6.62） mm Hg vs. （172.33±10.44） mm Hg, Plt;0.05〕 higher hydroxyproline content 〔 (0.43±0.05) μg/mg wet tissue vs. （0.50±0.29） μg/mg wet tissue, Plt;0.01〕 at the anastomotic stoma. ConclusionGhrelin may effectively promote the early recovery of rats after subtotal gastrectomy.
ObjectiveTo investigate the applicated value of carbon nanoparticle lymphatic tracer in laparoscopic assisted radical gastrectomy for advanced gastric cancer. MethodsForty-two patients with advanced gastric cancer who were admitted to the Department of General Surgery in The Affiliated Cancer Hospital of Zhengzhou University from March to September in 2014, were collected prospectively and randomly divided into two groups (carbon nanoparticle group and control group), each group enrolled in 21 cases. After improving relevant auxiliary inspection, subserosal injection of carbon nanoparticle around the tumor was performed via venous infusion needle laparoscopically at the beginning of surgery in carbon nanoparticle group, while the patients routinely underwent laparoscopic assisted radical gastrectomy in control group. Comparison of the results of harvested lymph nodes and its detection time between the two groups was performed, and the perioperative complications were also evaluated. ResultsA total of 678 lymph nodes were detected in carbon nanoparticle group and 447 lymph nodes were detected in control group. The number of harvested lymph nodes in carbon nanoparticle group (32.28±4.10) was significantly higher than that of control group (21.28±2.74), P < 0.05. The mean harvest time in carbon nanoparticle group was shorter than that of control group[(24.09± 3.58) min vs. (32.76±4.76) min, P < 0.05]. The proportion of harvested small lymph node (≤5 mm) in carbon nanoparticle group was higher than that of control group[71.68% (486/678) vs. 48.99% (219/447), P < 0.01]. The number of black-dyed harvested lymph node was 506 (74.63%) and the metastasis rate of black-dyed lymph node was 26.28% (133/506) in carbon nanoparticle group, that the metastasis rate of black-dyed lymph node group was significantly higher than those of without black-dyed lymph node group[6.40% (11/172)] and control group[19.24% (86/447)], P < 0.05. No serious side effect caused by carbon nanoparticle was observed. ConclusionsThe application of diluted carbon nanoparticle lymphatic tracer has a good effect in the dissection of lymph nodes in laparoscopic assisted radical gastrectomy for advanced gastric cancer. It improves the detection rate of lymph nodes, especially the small lymph nodes, and it is safe and feasible.