Objective To study the necessity and feasibility of No.12b lymph node dissection in D2 lymphadenectomy for advanced distal gastric cancer, and the relation between No.12b lymph node metastasis and clinicopathologic factors. Methods Clinical data of sixty cases of advanced distal gastric cancer receiving D2 or D2+ radical correction were collected retrospectively, both of which were all plus No.12b lymph node dissections. The relationships between No.12b lymph node metastasis and clinicopathologic factors were analyzed. Results No death attributed to operation or severe operative complications were found. There were 12 cases (20.00%) with No.12b lymph node metastasis. The rates of No.12b lymph node metastasis in Borrmann Ⅲ-Ⅳ types, N2-3 of lymph node metastasis and T3-4 of tumor infiltration were 31.25% (10/32), 30.30% (10/33) and 29.73% (11/37), which were significantly higher than those in Borrmann Ⅰ-Ⅱ types 〔7.14% （2/28）〕, N0-1 〔7.41% （2/27）〕 and T1-2 〔4.35% （1/23）〕 respectively (Plt;0.05). There was no relationship between tumor size and No.12b lymph node metastasis. Conclusions No.12b lymph node dissection is safe and feasible for advanced distal gastric cancer. Further perspective studies on No.12b lymph node dissection influence on prognosis in more cases are required.
Objective To assess the applied significance of carbon nanoparticles in central compartment lymph node dissection in treatment of cN0 papillary thyroid carcinoma. Methods Sixty-eight patients with cN0 papillary thyroid carcinoma who were treated in Tongji Hospital of Tongji Medical College from May. to Oct. in 2012 were randomly allocated to the control group （n=32） and the carbon nanoparticles trace group （tracer group， n=36）， receiving non-carbon nanoparticles trace and carbon nanoparticles trace respectively. All patients were received total resection of thyroid plus the affected side and （or） contralateral side central compartment lymph node dissection. The lymph node-related indexes（including number of dissected lymph node at Ⅵarea and lymph node metastasis rate at Ⅵarea） and operative indexs （including operation time， blood loss， drainage time， complication， and hospital stay） were collected and compared between the 2 groups. Results There were 205 and 324 dissected lymph node at central compartment in control group and tracer group respectively. The results of postoperative pathology showed that the number of lymph node in central compartment of the tracer group was much more than those of control group （8.99±2.24 vs. 6.41±1.56， P＜0.001）. The metastasis rate of central compartment lymph node were 40.6% （13/32） in control group and 47.2% （17/36） in tracer group， but there was no significant difference between the 2 groups （P=0.762）. But in medial area of laryngeal recurrent nerve， the metastasis rate in the tracer group （38.9%， 14/36） was much higher than those of control group （12.5%， 4/32）， P=0.029. There were no significant differences in the operation time， blood loss， drainage time， hospital stay， and complication incidence such as bleeding， temporary hypocalcemia， and injury of superior laryngeal nerve between 2 groups （P＞0.05）. All the patients in 2 groups had followed-up for 6 months without death， recurrence， and metastasis.Conclusions The lymphatic tracer technique of carbon nanoparticles may improve the number of dissected lymph nodes in central region of cN0 papillary thyroid carcinoma， without increasing （or prolonging） operation time， intraoperative blood loss， and postoperative hospital stay， and can accurately represent the metastasis of lymph node， thus to make the staging of the tumor accurately and guide postoperative treatment.
ObjectiveTo summarize the research progress of mucinous breast cancer (MBC). MethodsLiteratures about the recent studies of MBC were reviewed. ResultsMBC was one of special subtype of infiltrating breast cancer. According to the mucus ingredient in the ratio of the mass, MBC was divided into pure mucinous breast cancer (PMBC) and mixed mucinous breast cancer (MMBC). Compared to infiltrating ductal cancer-not otherwise specified (IDC-NOS), MBC showed higher positive expression rates of estrogen receptor (ER) and progestrogen receptor (PR), with reduced lymph node metastasis rate and better prognosis. PMBC had lower lymph node metastasis rate and better outcome than MMBC. ConclusionsThere is significant difference about clinical and pathological characteristics between MBC and IDC-NOS. Researches are generally believed that MBC is an uncommon breast neoplasm which is associated with a good prognosis.
Objective To investigate the feasibility, curative effect and perioperative treatments of lobectomy for pulmonary diseases by complete videoassisted thoracoscopic surgery (VATS). Methods Fiftysix patients of pulmonary diseases were treated with thoracoscopic lobectomy (including mediastinal and hilar lymph node dissection for malignant diseases) from March 2006 to November 2007 in our Department. Twelve right upper lobectomy, three right middle lobectomy, fifteen right lower lobectomy, nine left upper lobectomy, fourteen left lower lobectomy and three bilobectomy were carried out. The bilobectomy included one right upper and middle lobectomy, two right middle and lower lobectomy. Mediastinal and hilar lymph node dissection was simultaneously performed in the malignant cases. The feasibility, safety and postoperative complications were retrospectively analyzed. Results Fiftytwo patients (92.8%) were performed successfully by complete VATS. The median operative duration and blood loss were respectively 107±29min(from 45min to 168min) and 121±32 ml(from 50ml to 310ml). The incision in two cases (3.6%) were elongated to around 8 cm, the ribs were retracted, and the operations were completed by the help of VATS. Another two patients (3.6%) were changed to conventional thoracotomy for pneumonectomy or hemostasis. The postoperative pathology diagnosis was lung cancer in thirty nine, tuberculoma in seven, inflammatory pseudotumor in four, indurative angioma in four, bronchiectasis in one and metastasic chondrosarcoma in one. There was no surgical mortality. One case suffered from atelectasis in the middle lobe postoperatively and was cured by phlegm suction with bronchoscopy. Two air leakage healed automatically in three days. No other severe complications was observed. The average postoperative hospitalization was 8.9±3.1 d(from 8 d to 14 d). Conclusion Lobectomy for pulmonary diseases by complete VATS is technically fieasible, safe, minimally invasive with less complications and fast rehabilitation.
【Abstract】 Objective To introduce the recent studies about the lymph node-targeted chemotherapy for gastric carcinoma. Methods The literatures on the lymph node-targeted chemotherapy for gastric carcinoma in recent years were collected and reviewed. Results The lymph node-targeted chemotherapy for gastric carcinoma was effective because it couled improve the drug concentrations in regional lymph node. Conclusion As a part of multiple treatments for gastric carcinoma, lymph node-targeted chemotherapy will be further developed.
ObjectiveTo investigate the expressions of contactin-1 (CNTN-1), vascular endothelial growth factor-C (VEGF-C), and its receptor VEGFR-3 (Flt-4) in primary gastric cancer and to explore the relevance among them and their correlation with clinicopathologic features of gastric cancer. MethodsThe VEGF-C, VEGFR-3, and CNTN-1 protein expressions of tumor tissues and normal gastric mucosa tissues in 68 patients with primary gastric cancer were analyzed by immunohistochemistry. The Flt-4-positive vessel density (FVD) and lymphatic vessel density (LVD) were also analyzed by VEGFR-3positive and D2-40-positive staining, respectively. ResultsThe positivity rate of VEGF-C, VEGFR-3, and CNTN-1 protein expression in the primary tumor was 57.4% (39/68), 60.3% (41/68), and 55.9% (38/68), respectively, which was significantly higher than that in the normal gastric mucosa tissues 〔20.6% (14/68), 23.5% (16/68), and 16.2% (11/68)〕， P=0.000. The expressions of VEGF-C, VEGFR-3, and CNTN-1 protein were significantly correlated with TNM stage, lymphatic vessel invasion, and lymph node metastasis (Plt;0.05). The expression of CNTN-1 protein was significantly correlated with VEGF-C (r=0.372, P=0.002) and VEGFR-3 protein expression (r=0.308, P=0.011). In tumor tissues of sixtyeight patients the FVD was (10.41±9.38)/HP, which was significantly lower than LVD 〔(18.19±7.44)/HP〕, P=0.000. Elevated FVD and LVD was significantly found in patients with tumor characterized by later TNM stage, severer lymphatic vessel invasion, and severer lymph node metastasis (Plt;0.05). The FVD of tumor was significantly correlated with VEGF-C (P=0.029) and CNTN-1 protein expression (P=0.003). The LVD of tumor was not significantly correlated with CNTN-1 (P=0.727), VEGF-C (P=0.173), and VEGFR-3 protein expression (P=0.924). The patients with positive expression of VEGF-C, VEGFR-3, and CNTN-1 protein showed poorer prognosis (Plt;0.05). ConclusionsElevated expression of CNTN-1 protein is observed in primary gastric cancer and correlated with VEGF-C and VEGFR-3 protein expression, indicating that combined detection has great value in prediction of invasive potential and prognosis. VEGF-C-mediated CNTN-1 overexpression may promote lymphatic invasion via lymphangiogenesis pathway in patients with gastric cancer.
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.
ObjectiveTo investigate the condition of neck lymph node metastasis and related factors in thyroiditis coexisting thyroid cancer, and make clear the indication of neck lymph node dissection. MethodsA retrospective cohort study was conducted with the clinical data of 147 patients with thyroiditis coexisting thyroid cancer who underwent radical resection of thyroid cancer (total thyroidectomy or subtotal thyroidectomy) and neck lymph node dissection, including age, gender, tumor size, number of focuses, and lymph node metastasis. Results Among 147 patients, 65 patients with neck lymph node metastasis (44.22%), central cervical lymph node metastasis rate was 36.05% （53/147）， which was higher than that of lateral lymph node metastasis rate (20.41%, 30/147), Plt;0.05. Neck lymph node metastasis rate was correlated with patient’s gender and tumor size （Plt;0.05）, while it was not correlated with patient’s age and number of focuses (Pgt;0.05). ConclusionCentral neck lymph node metastasis rate is higher in patients with thyroiditis coexisting thyroid cancer, then routine prophylactic central neck lymph node dissection is significant. Patient’s gender and tumor size are correlated with neck lymph node metastasis. When tumor is larger or in male, ipsilateral lymph node dissection should be considered to done.
Objective To summarize and analyze the different views on the lymph node metastasis and the extent of lymphadenectomy in gastric cancer.Methods The current domestic and foreign reports on lymph node metastasis and lymphadenectomy in gastric cancer were reviewed.Results Lymph node dissection of gastric cancer is based on clinical stage and the location of the tumor. Laparoscopic-assisted gastrectomy in treatment of gastric cancer is a safe， feasible， effective， and minimally invasive technique with good outcomes for patients. Sentinel lymph node（SLN） in the clinical assessment of early gastric cancer is feasible，besides with high accuracy and sensitivity. Lymphatic mapping is an effective， easy， and safe method to guide lymphadenectomy in gastric cancer. Evidence-based lymphadenectomy in gastric cancer provide a new perspective to the extent. Conclusions It is difficult to evaluate those methods exactly. Researchers over the world should learn from each other and explore further in order to develop guiding principles in the end.
Objective To evaluate the safety and advantage in lymph node dissection of Ivor-Lewis esophagectomy in patients with esophageal cancer. Methods Clinical and pathological data of 78 patients with esophageal cancer who underwent Ivor-Lewis esophagectomy between September 2012 and March 2014 were collected and analyzed. Another 86 esophageal cancer patients who underwent esophagectomy of Sweet procedure during the same period were regarded as the controls. Duration of surgery, intra-operative blood loss, incidence of main complications and positive rate of lymph node were compared between the two groups. Results The duration of surgery in Ivor-Lewis group [(254.5±38.4) minutes] was longer than that in the Sweet group [(216.7±31.3) minutes]; and the average intra-operative blood loss in Ivor-Lewis group [(165.5±40.3) mL] was higher than that in the Sweet group [(148.7±35.4) mL]; the differences were significant (P < 0.01). Incidence of hoarseness in Ivor-Lewis group was significantly higher than that in Sweet group (P < 0.05), while incidences of other comp lications between the two groups were similar (P > 0.05). The proportion of patients with positive lymph nodes in Ivor-Lewis group (60.3%, 47/78) was significantly higher than that in Sweet group (26.7%, 23/86) (P < 0.05). Average number of lymph nodes dissected in Ivor-Lewis group (21.5±5.3) was significantly higher than that in Sweet group (10.6±4.1). Lymph nodes along the right recurrent laryngeal nerve was the most common metastasis in patients of Ivor-Lewis group, while lymph nodes in that area in Sweet group patients could hardly be dissected. Conclusions Ivor-Lewis esophagectomy is a safe surgical procedure for esophageal cancer. Ivor-Lewis procedure has more advantages in lymph node dissection than Sweet procedure.