Objective To investigate the significance and surgical skill for lymphadenectomy around common hepatic artery in gastric cancer. Methods Two hundred and fifty-seven cases with undergoing lymphadenectomy around common hepatic artery in gastric cancer between January 2001 and December 2006 were retrospectively reviewed. Experiences and understanding of dealing with this procedure in curative gastrectomy for gastric cancer were concluded. Results The number of dissected No.8 lymph node was 2.2±1.7, and the positive rate of No.8 lymph node was 30.35%. There were no lymphadenectomy related complications, such as anastomotic leakage, lymphatic fistula and postoperative hemorrhage in this series. Dissection around common hepatic artery lymph nodes along artery intrathecal space, division and ligation of left gastric vein at its root, and sufficient exposure of anatomic structures were important to dissection lymph nodes around the common hepatic artery. The exposure of anatomic structures included liberation of common hepatic artery by traction with the band, and the exposure of posterior side of pancreas by Kocher incision.Conclusion Being familiar with the anatomy around common hepatic artery, careful dissection, and attention to the surgical skill of lymphadenectomy are very important to improve the effectiveness of lymphadenectomy around common hepatic artery in gastric cancer.
Objective To investigate the effect and surgical skill of ultracision harmonic scalpel in curative gastrectomy for patients with gastric carcinoma. Methods From January 2007 to May 2008, the data of 152 patients who were treated by curative gastrectomy with ultracision harmonic scalpel were analyzed retrospectively. Results The mean operative time was (189.5±24.2) min. Compared with the conventional operation, the number of harvested lymph nodes (mean: 30.4±11.6) in patients treated with ultracision harmonic scalpel was increased. The application of ultracision harmonic scalpel could shorten the operation time, decrease the intraoperative blood loss and make the operation field clear. There were no postoperative complications, such as anastomotic leakage, lymphatic leakage and massive hemorrhage. And there was no death in this series. Conclusion The usage of ultracision harmonic scalpel which could improve the curative degree of lymphadenectomy is safe in curative gastrectomy for patients with gastric carcinoma.
To evaluate the relations between the protein nm23 expression and infiltration and metastasis of gastric cancer. Sixty seven samples of gastric cancer resected were examined with LSAB-immunohistochemical method, and the protein nm23 expression in gastric cancer cells were studied. Results: Total positive rate of the protein nm23 expression in gastric cancer cells was 68.7%. There were significant differences among different histopathological types degrees of differentiation, extent of infiltrative and metastasis (Ｐ＜0.05). Conclusion: The positive rate of protein nm23 expression in gastric cancer cells is 68.7%, which is highly related to the pathological type degree of differentiation, extent of infiltration and metastasis of the tumor.
Objective To detect the expression of thromhospondin-1 （TSP-1） in gastric cancer and metastaticlymph node tissues， and to study its relationship of TSP-1 to clinicopathologic parameters or tumor angiogenesis. Methods The TSP-1 and vascular endothelial growth factor （VEGF） expressions and microvessel density （MVD） were evaluated by immunohistochemistry in 72 specimens obtained by gastric resection from patients with gastric cancer， including corres-ponding adjacent normal gastric mucosa tissues （distant from cancer ≥5 cm） and lymph nodes surrounding cancer. A semiquantitative scoring system was used for evaluating the staining. The relationship of TSP-1 to VEGF expression， MVD， or clinicopathologic parameters was analyzed. Results ① TSP-1 positive expression rate was 45.8% （33/72） in the primary gastric cancer tissues， 90.3% （65/72） in the corresponding adjacent normal gastric mucosa tissues， and 50.8% （30/59） in the metastatic lymph nodes tissues. The expressions of TSP-1 in the primary gastric cancer tissues and metastatic lymph nodes tissues were significantly lower than those in the adjacent normal gastric mucosa tissues （χ2=32.710，P=0.000；χ2=25.298， P=0.000）. The expression of TSP-1 had no statistical significance in the primary gastric cancer tissues as compared with in the metastatic lymph nodes tissues （χ2=0.327， P=0.568）. ② The expression of TSP-1 in the metastatic lymph nodes tissues was significantly lower than that in the non-metastatic lymph nodes tissues （Z=-2.573， P=0.010）. ③The expression of TSP-1 in the primary gastric cancer tissues and metastatic lymph nodes tissues suggested a negative correlation with VEGF （rs=-0.309， P=0.008；rs=-0.269， P=0.040） and MVD （rs=-0.348， P=0.003；rs=-0.272， P=0.037）. Conclusions TSP-1 expression is down-regulated and has a negative correlation with VEGF and MVD in the primary gastric cancer and the metastatic lymph nodes tissues. According to the present results， it seems likely that TSP-1 is a tumor angiogenesis inhibitor.
ObjectiveTo investigate the potential role of caudal type homeobox transcription factor-2 (CDX-2) and liverintestine cadherin (LI-cadherin) in the development and progression of gastric tumor by detecting their expressions in gastric cancer and benign lesions. MethodsThe expressions of CDX-2 and LI-cadherin protein were detected by immunohistochemistry in normal gastric mucosa (n=28), chronic superficial gastritis (n=30), chronic atrophic gastritis (n=42), intestinal metaplasia (n=58), gastric adenocarcinoma (n=46), vicinity cancerous tissue (n=30), and gastric stromal tumor (n=10)．Then, the relationship between expression of CDX-2 or LI-cadherin protein and clinicopathologic features was analyzed． Results①The expressions of CDX-2 and LI-cadherin were all negative in normal gastric mucosa, chronic superficial gastritis, vicinity cancerous tissue, and gastric stromal tumor. The positive rates of CDX-2 protein expression in intestinal metaplasia and gastric adenocarcinoma were 91.4% (53/58) and 80.4% (37/46), respectively, and the positive rates of LI-cadherin protein expression were 82.8% (48/58) in intestinal metaplasia and 65.2% (30/46) in gastric adenocarcinoma. The positive rates of CDX-2 and LI-cadherin protein expression in intestinal type gastric adenocarcinoma 〔90.6% (29/32) and 78.1% (25/32)〕 were higher than those in diffuse type gastric adenocarcinoma 〔57.1% (8/14) and 35.7% (5/14)〕, Plt;0.05． ② CDX-2 protein expression was associated with degree of differentiation (P=0.007), and LI-cadherin protein expression was associated with lymph node metastasis (P=0.007) and cancer staging (P=0.013). ③ In the mucosa of intestinal metaplasia, the coexpression positive rate of CDX-2 protein expression in nucleus with LI-cadherin protein in cytoplasm or membrane was 83.0% (44/53), while the coexpression positive rate was 67.6% (25/37) in gastric adenocarcinoma. Although b tendency between CDX-2 and LI-cadherin protein expression was showed, it was not confirmed by the correlation analysis (r=238， P=0.115). ConclusionsThe abnormal expressions of CDX-2 and LI-cadherin may be involved in the development and progress of intestinal metaplasia and gastric adenocarcinoma, respectively, and further studies are needed to determine if they have synergistic effect.
Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction: one group with gastroesophagostomy (GE group) and the other with accommodation double tract digestive reconstruction of jejunal interposition (GIE group). The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation: the value of weight, RBC, Hb, Alb, PNI and the indexes versus the preoperative ones (Pgt;0.05), for the exception of the indexes of RBC (P=0.006), Hb (P=0.001) in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group (Plt;0.001). The Visick scoring: most of the GIE group were gradeⅡ (74.2%), and grade Ⅲ (64.3%) in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group (Pgt;0.05), and the surgical time was (0.35±0.13) h more than that of GE group (P=0.01). Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.
Objective To evaluate the capability of 64 multidetector CT in the differentiation between mucinous and nonmucinous gastric cancer. Methods From June 2006 to June 2007, 68 patients diagnosed as gastric cancer (18 mucinous and 50 nonmucinous cancer) underwent preoperative scan with a 64-slice helical CT scanner at West China Hospital. The CT images were analyzed retrospectively on tumor location (proximal/distal stomach), diameter of tumor, appearance of thickened gastric wall, contrast enhancement pattern (layered/nonlayered), degree of enhancement and serosal invasion. Results The primarily thickened layer (94% of patients) was the low attenuation middle layer in mucinous cancer and the rate was 72% with high attenuating inner layer or entire layer in nonmucinous cancer. The most common contrast enhancement pattern and degree was layered (83% of patients) and non-enhanced (89% of patients) in mucinous cancer and nonlayered (76% of patients) with enhanced (60%of patients) in nonmucinous cancer. The more common serosal invasion was shown in mucinous cancer than in nonmucinous cancer （89% vs 64%）. These findings were statistically significant (P＜0.05). Tumor location and size of gastric cancer were not correlated with operative pathologic classification. Conclusion Sixty-four multidetector CT is effective in distinguishing mucinous from nonmucinous gastric cancer, predominantly on the basis of thickened and layered gastric wall, enhancement pattern of low-attenuating middle layer.
ObjectiveTo explore feasibility and safety of π-shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy (TLTG).MethodThe clinical data of 20 patients who underwent TLTG, admitted in the Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2018 were retrospectively analyzed.ResultsTLTG with π-shaped esophagojejunal anastomosis was successfully carried out in all 20 patients. The operative time was (236.0±55.5) min, the π-shaped esophagojejunal anastomosis time was (25.7±4.8) min, the intraoperative blood loss was (192.0±148.9) mL, the operative incision length was (3.7±0.8) cm. The postoperative pain score was 2.4±1.1, the first flatus time was (3.1±0.9) d, the first postoperative ambulation time was (1.8±0.7) d, the removal time of nasoenteral nutrution tube was (7.4±2.4) d, the liquid diet time was (6.2±1.4) d, the removal time of intraoabdominal drainage tube was (7.8±2.8) d, the postoperative hospital stay was (10.8±3.0) d. There was no death related to the anastomosis in all patients. Two patients developed a little pleural effusion and 1 patient developed lymphatic leakage were cured with conservative treatment. One patient with intraabdominal encapsulated effusion was cured by puncture and drainage treating. There was no postive incisal margin. The length of upper segment of resection form gastric cancer was (2.3±1.7) cm, the maximum tumor diameter was (4.9±2.8) cm, the number of dissected lymph nodes was 27.9±5.6. All patients were followed up 3–15 months. Eight patients underwent endoscopic examination had no obvious anastomosis stenosis and esophageal reflux. Two patients died of tumor recurrence and metastasis witnin one year after operation, and the rest had disease-free survival until the end of follow-up.ConclusionFrom preliminary results of limited cases in this study, π-shaped esophagojejunal anastomosis in TLTG is a technically safe and feasible surgical procedure in treatment of gastric cancer.