ObjectiveTo analyze the factors influencing the total number of harvested lymph nodes in laparoscopic radical gastrectomy for advanced gastric cancer.MethodsThe clinicopathologic data of patients who underwent laparoscopic D2 radical resection of gastric cancer in this hospital for advanced gastric cancer from January 2018 to July 2020 were retrospectively analyzed. The statistical analysis was conducted to analyze the influence factors (age, gender, tumor size, tumor site, body mass index, infiltration depth, lymph node metastasis, HER-2 gene amplification status, presence or absence of vascular tumor thrombus, presence or absence of nerve infiltration, differentiation type, pTNM, Borrmann type, and type of gastrectomy) on the number of harvested lymph nodes.ResultsA total of 536 patients met the inclusion and exclusion criteria were included. The results of univariate analysis showed that the total number of harvested lymph nodes during laparoscopic radical gastrectomy for advanced gastric cancer was correlated with age, tumor size, tumor infiltration depth, lymph node metastasis, pTNM stage, Borrmann type, and type of gastrectomy. That was, the younger the patient was (≤ 54 years old), the larger the tumor was (long diameter >3.5 cm), the later the Borrmann classification was (type Ⅲ, Ⅳ), the deeper the tumor invasion was, the more the number of lymph node metastasis was, the later the pTNM stage was, and the more the number of lymph nodes was detected in patients undergoing total gastrectomy (all P<0.05). The multiple linear regression analysis showed that the age, lymph node metastasis, and PTNM stage had significant effects on the number of harvested lymph nodes. The multiple linear regression model was statistically significant (F=6.754, P<0.001). 11.2% of the variation in the number of harvested lymph nodes could be explained by the age, lymph node metastasis, and pTNM stage (adjusted R2=11.2%). ConclusionsNumber of harvested lymph nodes in laparoscopic radical gastrectomy for advanced gastric cancer is greatly affected by the age of patients, lymph node metastasis, and pTNM stage. So patients should be evaluated objectively and individually according to their age so as to harvest sufficient number of lymph nodes, which is conducive to accurately judge pTNM stage, formulate accurate adjuvant treatment scheme, and improve prognosis of patients.
Objective To investigate the clinical effects and safety differences of open surgery and laparoscopy primary lesion resection combined with D2 lymph node dissection in the treatment of elderly patients with advanced gastric cancer. Methods One hundred and forty elderly patients with advanced gastric cancer were chosen and randomly divided into two group including open operative group (70 patients) with primary lesion resection combined with D2 lymph node dissection by open operation and laparoscopic surgery group (70 patients) with primary lesion resection combined with D2 lymph node dissection by laparoscopy; and the operative time, intraoperative bleeding amount, the levels of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of haemoglobin (Hb) after operation, the hospitalization time, the number of lymph node dissection, the survival rate with followed-up and postoperative complication incidence of both groups were compared. Results There was no significant difference in the operative time between 2 groups (P>0.05). The intraoperative bleeding amount, the level of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of Hb after operation and the hospitalization time of laparoscopic surgery group were significantly better than open operative group (P<0.05). The level of PaCO2 in operation of laparoscopic surgery group was significantly higher than open operative group (P<0.05). There were no significant difference in the gastric lymph node dissection number and the peripheral lymph node dissection number of gastric artery between 2 groups (P>0.05). There were no significant difference in the survival rates between the 2 groups after 3-year followed-up (P>0.05). The complication incidence after operation of laparoscopic surgery group was significantly lower than open operative group (P<0.05). The quality of life scores of patients in laparoscopic surgery group were significantly higher than those in open operative group on 7 days and in 3 months after operation, and the difference were statistically significant (P<0.05). Conclusion Compared with open operation, primary lesion resection combined with D2 lymph node dissection by laparoscopy in the treatment of elderly patients with advanced gastric cancer can efficiently possess the advantages including minimally invasive, shorter recovery time and less postoperative complications.
ObjectiveTo compare the clinical recovery and immune response between laparoscopic-assisted and open D2 gastrectomy for advanced gastric cancer. MethodsThe clinical data of 53 patients with advanced gastric cancer from January 2012 to October 2013 were studied prospectively. According to random number table, patients were randomly divided into laparoscopic-assisted group(LA group, n=27) and open operation group(OO group, n=26). Operative time, blood loss, time to passage of flatus, time to resume soft diet, after bed time, postoperative hospital stay, and number of retrieved lymph nodes were compared respectively between the two groups. The changes in CD3, CD4+, CD8+, IgG, IgA, IgM, and CRP were examined respectively by using flow cytometry and immunoturbidimetric assays on the preoperative day 1, and on the postoperative day 1 and 7. ResultsThe operative time was longer significantly in LA group than that in OO group(P < 0.05). The mean blood loss, the first flatus time, after bed time, and postoperative hospital stay in the two groups were all different statistically(P < 0.05), and all were better in LA group. However, the mean number of retrieved lymph nodes and the time to resume soft diet were not significantly different in the two groups(P > 0.05). On the day 1 and 7 after operation, the CD3, CD4+, and CD8+ significantly decreased as compared with those preoperatively in two groups(P < 0.01, P < 0.05). On the day 1 after operation, the levels of IgG, IgA, and IgM significantly decreased as compared with those preoperatively in two groups(P < 0.05). Those immunoglobulin in LA group recovered to close to the level before surgery, but in OO group sustained lower level(P < 0.05). On the day 1 and 7 after operation, CRP level significantly increased as compared with those preoperatively in two groups(P < 0.01, P < 0.05). Those changes of above index were not significantly different between the LA group and OO group on the day 1 after operation(P > 0.05). All index recovered gradually in the two groups on the day 7 after operation and were better in LA group(P < 0.05, except IgA). ConclusionLaparoscopic radical gastrectomy for advanced gastric cancer resulted in a quicker clinical recovery and a lesser depression to the perioperative cellular and humoral immune function.
Objective To explore the feasibility, safety, efficacy and mechanism of intraoperative regional chemotherapy of advanced gastric cancer.Methods The related literatures were reviewed and analyzed. Results Compared with systemic chemotherapy, intraoperative regional chemotherapy of advanced gastric cancer could increase blood drug concentration of cancerous tissue, reduce the systemic toxic side effects, increase survival rate and improve the quality of life. Conclusion Intraoperative regional chemotherapy, as an adjuvant treatment of advanced gastric cancer, has been gradually applied to clinic because of the definite curative effect, which is worth popularizing. However, it needs systemic researches and accumulation of cases.
Objective To investigate the feasibility and safety of laparoscopic-assisted gastrectomy for distant gastric cancer. Methods All 18 patients with distant gastric cancer receiving laparoscopic-assisted gastrectomy were analyzed. Results Laparoscopic-assisted distal gastrectomy was performed successfully in all patients. The mean operation time was (291.33±19.61) min. The mean blood loss was (151.32±71.78) ml. The mean numbers of harvested lymph node were 14.57±3.11. The mean time of gastrointestinal function recovery was (3.46±0.93) d, the mean out of bed activity time was (1.75±0.45) d. All patients were followed up for 1-24 months, mean 11 months. No local recurrence, trocar implant or distant metastasis happened. Conclusion Laparoscopic-assisted gastrectomy is a feasible and safe surgical procedure combined with minimal trauma and fast recovery.
ObjectiveTo summarize the research progress of preoperative regional-arterial chemotherapy in advanced gastric cancer. MethodThe literatures about the research progress of preoperative regional-arterial chemotherapy in the advanced gastric cancer were reviewed. ResultsThe preoperative regional-arterial chemotherapy in the advanced gastric cancer could decrease the tumour stage, improve the R0 resection rate and the long-term survival rate, effectively improve the drug concentrations of tumor and portal vein, and not only kill or damage cancer cells directly, but also prevent the metastasis of liver and lymph nodes effectively, and reduce the side effects, cause the nuclear pyknosis and fracture of cancer cells in a short time. The course of preoperative regional-arterial chemotherapy in the advanced gastric cancer generally was 4-9 weeks, and then whether the surgery treatment was decided to undergo according to the results of the curative effect evaluation. ConclusionsThe preoperative regional-arterial chemotherapy in the advanced gastric cancer has more advantages than intravenous chemotherapy, further research of multicenter and large clinical trials, would inaugurate a wider application prospects.
Objective To evaluate the efficacy and safety of intraoperative mesenchymal chemotherapy with 5-FU implants in radical gastrectomy of advanced gastric cancer. Methods From January 2008 to September 2009， 102 patients with historically proven advanced gastric cancer were enrolled in our department and were allocated to undergo either radical gastrectomy and intraoperative mesenchymal chemotherapy with 5-FU implants 800 mg（treatment group， n=51）， or radical gastrectomy alone （control group， n=51）. The postoperative complications and recurrence rate between two groups were compared. Results There were no significant differences on the volume of abdominal cavity drainage， count of white blood cells， albumin level， and gastrointestinal adverse events between the two groups （P＞0.05）. After a median follow-up of 28 months， the local recurrence rate was lower among patients in treatment group than that in control group （16.3% vs. 39.1%， P＜0.05）， the survival rate of 3-year was higher in treatment group than that in control group （85.8% vs. 67.3%， P＜0.05）. Conclusions Compared with the control group， there are no significant adverse reactions on patients with advanced gastric cancer who were implanted fluorouraci1 implants during operation， which can reduce local recurrence rates and improve the survival rates.
Through searching and evaluating the evidence on advanced prostate cancer, we found that different types of androgen deprivation had similar effect, and immediate androgen deprivation had survival benefit. For the patient with hormone-refractory prostate cancer, therapies including mitoxantrone, prednisone, docetaxel and surmine were more effective. Strontium-89 provided more effective pain relief than external beam radiation. And bisphophonate had no effect. Antiandrogen withdrawal suggested prostate specific antigen would decline, but the clinical outcome wasn’t reported.
Objective To evaluate the effectiveness and safety of postoperative intraperitoneal hyperthermic perfusion chemotherapy (IHPC) for advanced gastric cancer, so as to provide references for clinical practice and study. Methods The following databases including The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and WanFang were searched on computer, and other searches were also performed to collect all relevant randomized controlled trials (RCTs) on postoperative IHPC versus intravenous chemotherapy alone (IC) for advanced gastric cancer. The quality of the included studies was assessed according to Cochrane Handbook 5.1 for Systematic Review, and Meta-analysis was conducted by using RevMan 5.1 software. Results A total of 18 RCTs involving 2299 patients were included. The results of meta-analyses showed that: a) Efficacy evaluation: There were significant differences between the IHPC group and the IC group in 1-, 2-, 3-, and 5-year survival rate, 3- and 5-year recurrence rate, and 3- and 5-year distant metastasis rate; the OR value and 95%CI were 1.88 (1.49, 2.39), 2.45 (1.64, 3.67), 2.29 (1.92, 2.73), 2.17 (1.70, 2.76), 0.39 (0.29, 0.52), 0.54 (0.40, 0.72), 0.55 (0.38, 0.78), 0.58 (0.42, 0.81), respectively; b) Safety evaluation: There were significant differences between the IHPC group and the IC group in the incidence of abdominal pain, abdominal distension, nausea and vomiting; the OR value and 95%CI were 2.20 (1.58, 3.07), 7.00 (2.67, 18.36), 0.65 (0.45, 0.95), respectively. But there were no significant differences between the IHPC group and the IC group in the incidence of alopecia, ileus, bone marrow inhibition, and hepatic lesion. Conclusion Compared with IC, postoperative IHPC+IC can improve survival rate and reduce the recurrence and distant metastasis rate; additionally, it is safe and feasible, so it is recommended that the detailed condition of patients should be taken into consideration when the postoperative IHPC+IC therapy is applied to clinic.
ObjectiveTo systematically review the efficacy and safety of neoadjuvant chemotherapy containing tegafur gimeracil oteracil potassium (S-1) combined with surgery in the treatment of advanced gastric cancer.MethodsWe searched EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI and WanFang Data from inception to February 2017, to collect randomized controlled trials (RCTs) about neoadjuvant chemotherapy containing S-1 combined with surgery in the treatment of advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 971 advanced gastric cancer patients were included. The results of meta-analysis showed that the neoadjuvant chemotherapy containing S-1 combined with surgery group was superior to the control group in R0 resection rate (OR=2.75, 95%CI 1.91 to 3.95, P<0.000 01), 2 year survival rate (OR=1.72, 95%CI 1.01 to 2.93, P=0.05) and 3 year survival rate (OR=1.64, 95%CI 1.12 to 2.41, P=0.01), while there were no statistical differences in response rate (OR=1.33, 95%CI 0.70 to 2.51, P=0.39), 1 year survival rate (OR=1.50, 95%CI 0.64 to 3.53, P=0.35) and the incidence of postoperative complications (OR=1.00, 95%CI 0.66 to 1.51, P=0.98).ConclusionNeoadjuvant chemotherapy containing S-1 combined with surgery can improve the R0 resection rate, 2-year survival rate and 3-year survival rate without increase postoperative complications rate. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.